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animegirle

Musings about scar tissue

I have been thinking about the nature of scar tissue and a few questions have come to mind.

I wonder if the body looks at scar tissue as living or dead. Does the abnormal skin become "normal" in the eye of the body, or does the body recognize a defect in that area?

What I mean by this is if you have a patient that has a decubitus or pressure ulcer/sore, it is usually covered by necrotic (dead) tissue. This inhibits the growth of new healthy tissue. Convential treatments for these ulcers usually are debridement, followed by the application of a topical designed to promote healthy skin growth. In addition the patients are kept on very well-balanced, high protien, nutrient rich diets (This is an excerpt from a study I was reading: Specific amino acids may also play an important role. For example, the amino acid arginine has been shown to enhance collagen deposition at the wound site.Vitamin C plays a major role in wound healing because it is essential for collagen synthesis and fibroblast formation).

It seems like that some of the creams that are used to stimulate new tissue growth and collagen synthesis could be applied to scar therapy. In conjunction with the proper diet and supplements. I have seen first hand (I am also a nurse) the regeneration of tissue from very badly damaged skin.

Right now I am studying and looking for a connection. I have a biopsy scar that I test on, I may be heading off to the ulcer aisle at the local home care store next...lol. I will post, as always, if there are any results.

Any thoughts/musing/ideas are always, always welcome!! biggrin.gif/

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Hi there, what kind of creams do they use for ulcers? Is the arganine applied topically or orally?

I looked at your pics, and your skin is so perfect I'd have to look to see your scars if you didn't point them out.

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Hi footprint,

All of the information so far points to arganine being ingested. I too wondered about the topical application, if it exists or if it is even possible.

There are multiple types of creams, some by prescription and some over the counter. The point where I hesitate is a lot of these creams have a debriding action, as well as stimulating new tissue growth. I am not sure how this translates to the delicate tissue of the face. I would be willing to experiment on my biopsy scar....

I am going to call some hospitals/facilities and see if there is anything they recommend for patients who might have an ulceration on their face. We'll see if I have any luck!

Thank you for the compliment on my skin. I know at this point it is not very noticable to others, but it is very noticable to me. I guess that is what happens after dealing with scar treatments over the last 12 years! Have a great day!!!

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Hi Animegirle,

I too have mused over this. I don't think the body ever truly accepts scar tissue as normal. I believe it is alive but not as alive as healthy tissue. Classically, scar tissue lacks pores, sweat glands, hair and pigment, and is more fibrous. It is like a missing limb; you might get used to it and learn to deal with it, but the regeneration of the limb would be a better thing.

The body does the best it can to deal with an injury as soon as possible and closes the wound by quickly building scar tissue.

In a way, I wonder if diabetic wounds aren't the opposite of the scar process. In the case of an ulcer the body is extremely slow in closing in the wound. Maybe this delay can ultimately allow for more perfect healing with the right growth factors.

There is so much I don't know! I really would like to sit down and talk with a scar research expert about this.

My best! Anna

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You make a very good inference and you may be on to something...keep researching.

As an aside that is somewhat of a coincidence, I had a cyst that finally drained after I washed my face. It was big, and I was afraid it would scar, so I decided to put on spenco gel..well, it's healing very well so far, but it's too soon to tell if it will keep a scar at bay.

It says on the box that it can be used for D. ulcers stages I-IV. It speeds the healing process using a polysaccharide. I think it works better than neosporin. It also says on the box that it helps prevent scars from forming.

I've had it for about a year. I originally bought it for a moisturizer. I'm glad I saw it sitting in my drawer when I was looking for my antibiotic ointment.

I'll keep you posted.

~Emma

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This is something I've been wondering about scars: Does it actually qualify as damaged collagen?

So many of these treatments we perform seem to bank heavily on "destroying, eating, dissolving" etc damaged collagen... But is the collagen inside a scar actually damaged? It would seem to me that it wasn't... Unless, of course, you do something to damage the fibers, like needling. Maybe then all of our nutrient acids (a la ALA) and copper peptides could do their work?

I think that's part of my problem. My copper peptides -do- help my skin... But they seem to be refining my scars, too. Not destroying them. Just making them look neater, more deliberate. It's odd.

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Okay, I used to work in a lab where I grew skin for burn victims, and have seen a LOT of microscopic exams of scar tissue. 1. The collagen is malformed. As in not properly aligned, and just irregular (lumps, clumps, running in the "wrong" direction, etc) 2. Remodeling of scar tissue has been seen to occur for as long as 6 years. Eventually, the process of remodeling slows down or seems to stop. 3. The immune reaction to scar tissue is to try to break it down, then lay down properly aligned tissue/collagen, which fibroblasts then inhabit. So, I dont think the body sees it as dead, just not proper. Note that this process occurrs also in regular skin tissue, just if there isnt much to remodel, theres not much to do. Collagen is constantly being broken down and re-laid, just at a much slower rate than is seen in scars. It seems to me that the processes we're undertaking (peels, needling, dermabrasion, smoothbeam) basically re-signal the remodeling process to get going at a higher level. I liken it to re-breaking a bone that has healed improperly. Also, scar remodeling can and will slow down after a while (its theorized that eventually the markers for healing are few in number, or the remaining scar is intractable due to density or other factors), so we re-trigger the remodeling/healing process by a sort of irritation to that area, or an outright disruption to the existing scar when more invasive processes (including smoothbeam, though its not classically "invasive". It has a wavelength that is absorbed by collagen. Therefore, it heats it up and breaks it down.) are used, like needling. There are probably two processes at work with needling: breaking scar that is holding down an area or making it uneven, and re-triggering an immune response that brings healing factors to the area, which then attempt to remodel pre-existing scar tissue while it heals the small wound we've created. Hope this helps!

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Divegod,

Thank you for the informative post. Do you know if re-triggering the skin (via needling, spot TCA etc) to small areas causes the remodeling process to be reactivated in the surrounding skin that has not been irritated (TCA, needling etc.)?

I ask because while examing the pics of this persons (http://www.cosmetic-medicine.jp/english/result/nikibikon/index.html)before and after with spot TCA treatment I notice the surrounding skin and smaller scars appear to be better too. Could be the lighting though.

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So with the great info from Divegod we can infer that keeping your immune system in top shape and taking supplements designed to improve would healing, and eating a diet geared toward tissue repair, such as the diets they recommend for burn patients or people recovering from ulcers, will indeed, over the long haul aid in the body's work of scar repair!

Even if we are not undergoing an invasive or non-invasive treatment for that matter, we can be working on the problem from the inside out.

I think it takes a multi-dimensional approach to battle scars!

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Hi all, and thanks for the kind words. I rarely post because sometimes my experience and training run counter to what people believe or want to believe, so I get grief. As for me, Ive gotten 85-90% improvement in some of my scars, but only about 30-50% in others, so there is no panacea out there. Animegirl (who I have a crush on biggrin.gif ) got it right, there needs to be a multidimensional approach to treating these things. Which leads me to my next thought......

We all have been pretty aggressive in doing things that disrupt the skin that covers (and is part of our scars). Retin a and the strong peels that we've all done (me included), in addition to smoothbeam and other lasers, causes a "wounding" of the skin in that it stimulates a repair process. However, this is only one phase of what needs to be done. Ive had much better success with cycling my treatments over time. For example, for several weeks (2 mos or so), Ill use retin a and peels to cause the repair response I want. But, I then back way off and add things like vit c (BTW, the PD intense gel is great. Not only smells good, has vit c and ALA, but soothes the skin also), for a while to encrouage collagen formation, then just highly moisturize for a while (or even just plain old vaseline ). I do this to stimulate migration of the fibroblasts into the area. So, youve got three phases as I see it: "Damage, response/remodel, migration/buildup". That way, the damage stimulates the repair/remodel process, the response can do its job and attack scar collagen, but then, when the new, better formed collagen is being laid down, youve got to provide the optimal environment for fibroblasts to migrate in. That environment is a moist, protected area, hence the use of vaseline or other "heavy" agents that block water loss in the area. Without migration of the fibroblasts into the area, youre just going to end up with high collagen/repair mechanism going, without the skin actually reforming its full layers. To my way of thinking, that leaves a continued indentation....which is where we all started.

So, what I do is just use vaseline in the evening for a few weeks, maybe a good vit c product every few nights. Spot treat, not over my whole face. If I break out, I use BP during the day. If not, a good moisturizer, like the manuka honey stuff that Im now finding in a few places.

Just got to thinking that maybe constant exposure to the exfoliating agents such as retin a and the varfious acids was maybe inhibiting a piece of the healing puzzle.

Anyway, after that, Ill basically do nothing for a week or so, maybe even longer and allow a little sun to get to my skin (do NOT allow yourself to burn. Tanning is very bad for your skin. I got completely flamed for even suggesting that sun might not be evil, so Im just throwing this out there as something I do. Ive got really, seriously tough skin, and I limit my exposure. But, Im not afraid to allow a little, minor tanning to take place once my skin has reached a full thickness again. But NOT before). Eventually, I get bothered by the scars again. Then back to the exfoliating stuff, and repeat the whole cycle.

As for the question, yes, surrounding tissue does benefit from what we do. The repair response is not limited to just the scar, and the increased collagen breakdown/remodel effect does help surrounding tissues.

So, thats what works for ME. Everyones skin reacts differently to stuff, that is why there are so many treatments and successes/failures with procedures out there. There is no ONE SINGLE thing that is going to work the same way on everyone, but I do get concerned that some people may be limiting their own healing by constantly having thinned skin due to peels, etc. It provides an easy way for other, more damaging effects (like the sun) to get thru the bodys natural defenses, and may inhibit the body's healing processes if continued too long. Just something to think about....

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Yet another great post. Please don't hesitate to share your knowledge.

I've been thinking lately that it's bad to have my skin in constant peeling, and I've worried about the damaging effects this may produce. I used to always think "the more you peel the better." Lately, I've been thinking about the harm I may be causing by having thin skin. I use retin-a for acne as well as scars. I'm pretty clear(except my chin,that's a whole other topic), but still acne prone. I'm afraid to put PD on my face, because I'm afraid I'll break-out.

Your post really makes a lot of sense, and I'd like to try it. I've already cut back on things, and my skin is a lot less oily. I wash with H20 in the a.m, and BP wash in the p.m. This little adjustment has made a big difference.

My question is: how do you know when it's time to switch modes? When do you know you've "got the response you want" and should start using the PD?

Thanks,

~Emma

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Brilliant Post Divegod!!!!

I have sort of been doing that myself over all these years....I would notice with, say the Retin-A that my skin would start to look worse at a point, then I would back off for about a month and start the cycle again.

I have noticed if I am exfoliating frequently that my skin will get very thin and almost frail looking. I have backed off from that regimen.

I also have to add that since I d/c'd the copper peptides my skin looks much better...go figure! We all know what works well for one......

BTW Divegod: "Animegirl (who I have a crush on)" Me<--Blushing smile.gif

doll%20copy.bmp

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Hello Animegirle,

Thank you so much for you very informative scar comments I learned quite abit. I wish you well in your endevors to discover an agent to help eradicate scar tissue completely. I will be one of your faithful consumers. I am very interested in your comment about what a burn victim is required to eat to aid healing. If you would please explain what a burn victim's diet consists of or where I can get a copy of one I would appreciate your efforts tremendously. Thank You Again, Linny

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Hello Divegod,

I read your great post on scars along with Animegirle. You two sound as if we should be scheduling appointments with you. You have contributed some much and I truly apprecate it. I wish you well in your ongoing research as well. Your comments about using a petroleum jelly product on your face brings a question to mind. I believe my mother used to put petroleum jelly on her face at night, but then she never had the skin problems her children had. The acne genes are from my fathers side of the family. Would olive oil accomplish the same effect? It would be lighter and not clog the pores so the facial skin could breathe. Or would this not accomplish the barrier to hold in the moisture? Thank you in advance for your reply, Linny

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Divegod,

In your experience in looking at scar tissue under the microscope, did the tissue first have a stain applied to it (I believe they call it Verhoeff-Van Gieson stain)? In my research I read somewhere that this stain will only color scar tissue and leave healthy tissue uncolored. If so, would you know if this could be used on living skin rather than just a lab sample? The reason I ask is that I was thinking that just like when a dentist uses a disclosing tablet on your teeth, to see where tartar has built up, you could apply this stain to your face to see exactly where you have scar tissue. What I am really trying to figure out is if my indentations have scar tissue or just not enough healthy tissue.

Thanks so much!

Anna

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hi, what do you guys think about taking niacin? I've been taking it while my TCA cross heals, in the hopes it'll improve circulation. I turn beet red, itch for a few minutes, and then I feel warm tingly and relaxed. It feels like it's doing something good.

Also I read somewhere - maybe it was this board - that when you take Vit C, you should also take vitamin E. The reason was something like, after C gives an electron to a free radical, it's now positive, and can act like a mild free radical itself. Somehow E helps the C get an electron back. Has anybody else heard that too?

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Niacin is supposed to be very good for raising your HDL (your "good" cholesterol), so I don't think it would hurt.

Which reminds me of something, which probably doesn't belong here, but I'll ask anyway. Does anybody else here have really low cholesterol? I just had mine checked it is only 140, but my bad cholesterol was kind of high in comparison to the good. I know of at least one other person with an acne problem with really low cholesterol and I read that taking accutane raises your cholesterol. I am trying to figure out if there is a connection.

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Olive oil would even, theoretically, be better. Theres a lot of antioxidants in olive oil, and it would probably be less comedogenic (sp?). But, would it stay in place for long enough? I dont think it would, which is why I use vaseline. Please give it a try though and tell us your results. I dont think it could hurt....

Yes, most of the tissue slides were stained in various ways. I dont think you could stain in vivo skin. 1. most of the stains used were a bit nasty, and I wouldnt want them on my skin. They can be pretty toxic. 2. The stain might not come off very easily (or ever!) and the prospect of walking around for a week with purple stains on my scars isnt very attractive! If youre not sure if its a scar, what are you concerned with? What are you trying to "see"? 3. The stains were mostly designed to separate collagen from the various other components. You could then see the malformed collagen against the background of cells. I think that if you did try to stain scars, you'd just end up staining all collagen in the area. I dont believe there was a stain specific to "scars", as there is for tartar.

No experience with niacin, but personally, Id be careful. Several different vitamins can be dangerous when taken in large quantities, so Id check with a physician before embarking on any regimen that would make you flush like that....Im thinking your liver might not be able to handle it over a long period. But again, Ive no experience with it.

Animegirl, you have the the most adorable pics on your site! More, please! BTW, where do you live? US or UK?

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I am very interested in your comment about what a burn victim is required to eat to aid healing.  If you would please explain what a burn victim's diet consists of or where I can get a copy of one I would appreciate your efforts tremendously.

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Divegod wrote:

Yes, most of the tissue slides were stained in various ways. I dont think you could stain in vivo skin. 1. most of the stains used were a bit nasty, and I wouldnt want them on my skin. They can be pretty toxic. 2. The stain might not come off very easily (or ever!) and the prospect of walking around for a week with purple stains on my scars isnt very attractive! If youre not sure if its a scar, what are you concerned with? What are you trying to \"see\"? 3. The stains were mostly designed to separate collagen from the various other components. You could then see the malformed collagen against the background of cells. I think that if you did try to stain scars, you'd just end up staining all collagen in the area. I dont believe there was a stain specific to \"scars\", as there is for tartar.  

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Also, scar remodeling can and will slow down after a while (its theorized that eventually the markers for healing are few in number, or the remaining scar is intractable due to density or other factors), so we re-trigger the remodeling/healing process by a sort of irritation to that area, or an outright disruption to the existing scar when more invasive processes (including smoothbeam, though its not classically \"invasive\".  It has a wavelength that is absorbed by collagen.  Therefore, it heats it up and breaks it down.) are used, like needling.  There are probably two processes at work with needling: breaking scar that is holding down an area or making it uneven, and re-triggering an immune response that brings healing factors to the area, which then attempt to remodel pre-existing scar tissue while it heals the small wound we've created.  Hope this helps!

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We used the VVG stain in the lab, and what I think theyre referring to is the ability to look at scarred tissue with the help of this stain. No where does it state that this is specific to scar tissue, only that it made it possible to differentiate from other tissues. Elastic tissues are generally (when talking about skin) referring to collagen. In other body parts, this might refer to structures such as ligaments, muscle fibers, etc. So, I guess it sounds a little misleading and like they were staining for SCAR TISSUE when in fact they were doing a collagen stain and then able to differentiate the malformed collagen from more normal collagen (and background material). Youve got to read these studies really critically, they can be (intentionally and otherwise) misleading.

It might be possible to modify the normal collagen staining technique to include a mordant that will allow greater binding to collagen, or binding to more dense patches of collagen, then rinse repeatedly so that the VVG stain adheres to the collagen clump (read: scar tissue) moreso than it does to the surrounding collagen. But, I dont think thats what they did, though I'd have to look at the methodology myself.

Repair of scar tissue is a progressive process. Its not an all or nothing situation. Its not "on" and then "off". Repeated treatments keep the process going. Smoothbeam disrupts collagen, and when directed at a scar, malformed collagen. This re-triggers the healing process.

Maybe Ive been unclear in some things Ive said. Scar tissue is NOT a distinct type of tissue in that its immunologically different than normal tissue, except for the fact that its misaligned and malformed. This misalignment is what causes and perpetuates the remodeling response. There isnt a "scar tissue" per se that is completely different than the surrounding tissues. Its a more dense, misaligned, and malformed complex of collagenous fibers.

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