Correcting High and Hypertrophic Scars with PCI

The keloids initiated in the reticular dermis project to the skin and do not regress spontaneously. They are erythematous-violaceous, skin-colored, or hyperchromic and are distinguished from elevated scars by exceeding the limits of initial injury. It is believed that there are no spontaneous keloids. Lesions without apparent causes were probably the result of a mild injury, not perceived by the patient. Techniques for keloid management have been used with variable responses, such as intralesional injections with bleomycin and corticosteroids alone or in association, cryosurgery, use of silicone plates, lasers, intense pulsed light, in addition to topical assets such as 5-fluorouracil, interferone, retinoids, 5% imiquimode, tacrolimus, verapamil. Botulinum toxin has shown good results in specific cases. Corticosteroids present side effects such as risk of secondary infection, atrophy, telangiectasis, and hypopigmentation. Cryosurgery, when performed by not very experienced professionals, can lead to atrophy and hypochromia, and bleomycin can trigger hyperpigmentation. PCI proposes to destructure fibrosis and abnormal collagen, creating hematic columns with production of a new collagen, without causing the deepithelialization observed in ablative techniques.