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Q:

I developed itchy eruptions over my old BCG scar site
Asked on 11/29/2014


A:
I developed itchy eruptions over my old BCG scar site


Scar: Pathophysiology

If a wound becomes covered with epithelial tissue within two weeks, minimal collagen will be deposited and no scar will form. Generally, if a wound takes longer than three to four weeks to become covered, a scar will form. Deep second-degree burns heal with scarring and hair loss. Sweat glands do not form in scar tissue, which impairs the regulation of body temperature.

The scar is a result of the body's repair mechanism after injury in many tissues.

Any injury does not become a scar until the wound has completely healed; this can take many months, or years in the worst pathological cases, such as keloids. To begin to patch the damage, a clot is created; the clot is the beginning process that results in a provisional matrix. In the process, the first layer is a provisional matrix and is not scar. Over time, the wounded body tissue then overexpresses collagen inside the provisional matrix to create a collagen matrix. This collagen overexpression continues and crosslinks the fiber arrangement inside the collagen matrix, making the collagen dense. This densely packed collagen, morphing into an inelastic whitish collagen scar wall, blocks off cell communication and regeneration; as a result, the new tissue generated will have a different texture and quality than the surrounding unwounded tissue. This prolonged collagen-producing process results in a fortuna scar.

The scarring is created by fibroblast proliferation, a process that begins with a reaction to the clot.

To mend the damage, fibroblasts slowly form the collagen scar. The fibroblast proliferation is circular and cyclically, the fibroblast proliferation lays down thick, whitish collagen inside the provisional and collagen matrix, resulting in the abundant production of packed collagen on the fibers giving scars their uneven texture. Over time, the fibroblasts continue to crawl around the matrix, adjusting more fibers and, in the process, the scarring settles and becomes stiff. This fibroblast proliferation also contracts the tissue. In unwounded tissue, these fibers are not overexpressed with thick collagen and do not contract.

The fibroblast involved in scarring and contraction is the myofibroblast, which is a specialized contractile fibroblast. These cells express a-smooth muscle actin (a-SMA).

The myofibroblasts are absent in the first trimester in the embryonic stage; damage then heals scar free; small incisional or excision wounds less than 2 mm also heal without scarring; and in adult unwounded tissues where the fibroblast in itself is arrested; however, the myofibroblast is found in massive numbers in adult wound healing which heals with a scar.

The myofibroblasts make up a high proportion of the fibroblasts proliferating in the postembryonic wound at the onset of healing. In the rat model, for instance, myofibroblasts can constitute up to 70% of the fibroblasts, and is responsible for fibrosis on tissue. Generally, the myofibroblasts disappear from the wound within 30 days, but can stay around in pathological cases in hypertrophy, such as keloids.

Prolonged inflammation, as well as the fibroblast proliferation can occur. Redness that often follows an injury to the skin is not a scar, and is generally not permanent (see wound healing). The time it takes for this redness to dissipate may, however, range from a few days to, in some serious and rare cases, a few years.

Scars form differently based on the location of the injury on the body and the age of the person who was injured.

The worse the initial damage is, the worse the scar will generally be.

Skin scars occur when the dermis (the deep, thick layer of skin) is damaged. Most skin scars are flat and leave a trace of the original injury that caused them.

Wounds allowed to heal secondarily tend to scar worse than wounds from primary closure.

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Bacillus Calmette-Guerin (BCG) Vaccine (TheraCys BCG): What SIDE EFFECTS can this medicine cause?

BCG vaccine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

  • swollen lymph nodes

  • small red areas at the site of injection. (These usually appear 10-14 days after injection and slowly decrease in size. They should disappear after about 6 months.)

  • fever

  • blood in the urine

  • frequent or painful urination

  • upset stomach

  • vomiting

If you experience any of the following symptoms, call your doctor immediately:

  • severe skin rash

  • difficulty breathing or swallowing

  • wheezing

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Old Location

The Old Location (or as it was known then the Main Location) was an area segregated for Black residents of Windhoek, the capital of Namibia. It was situated in the area of today's suburb Hochland Park.

Upon the creation of the neighborhood in 1912 by the Windhoek City Council, all Black residents of other areas of the city were moved to the Main Location. A year later, streets were laid out and the separation of Black ethnic groups took place, with each ethnic group forced to live in a different section. Administration of the area was split between Black local residents and White residents from elsewhere.

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Scar revision: Description

Scar tissue forms as skin heals after an injury (such as an accident) or surgery. The amount of scarring may be determined by the wound size, depth, and location; the person's age; heredity; and skin characteristics including color (pigmentation).

Depending on the the extent of the surgery, scar revision can be done while you are awake (local anesthesia), sleeping (sedated), or deep asleep and pain-free (general anesthesia).

Medications (topical corticosteroids, anesthetic ointments, and antihistamine creams) can reduce the symptoms of itching and tenderness. A treatment called silicone gel sheeting or ointment has been shown to benefit swollen, hypertrophic scars. There is no evidence showing that any other topical (applied directly to the scar) treatment works. In fact, Vitamin E applied directly to the skin may actually cause the wound to heal more slowly and may cause irritation.

When to have scar revision done is not always clear. Scars shrink and become less noticeable as they age. You may be able to wait for surgical revision until the scar lightens in color, which can be several months or even a year after the wound has healed. For some scars, however, it is best to have revision surgery 60-90 days after the scar matures.

There are several ways to improve the appearance of scars:

  • The scar may be removed completely and the new wound closed very carefully
  • Dermabrasion involves removing the upper layers of the skin with a special wire brush called a burr or fraise. New skin grows over this area. Dermabrasion can be used to soften the surface of the skin or reduce irregularities.
    • Massive injuries (such as burns) can cause loss of a large area of skin and may form hypertrophic scars. These types of scars can restrict movement of muscles, joints and tendons (contracture). Surgery removes extra scar tissue. It involves a series of small cuts (incisions) on both sides of the scar site, which create V-shaped skin flaps (Z-plasty). The result is a thin, less noticeable scar, because the way the wound closes after a Z-plasty more closely follows the natural skin folds.
  • Skin grafting involves taking a thin (partial, or "split thickness") layer of skin from another part of the body and placing it over the injured area. Skin flap surgery involves moving an entire, full thickness of skin, fat, nerves, blood vessels, and muscle from a healthy part of the body to the injured site. These techniques are used when a large amount of skin has been lost in the original injury, when a thin scar will not heal, and when the main concern is improved function (rather than improved appearance).
  • Tissue expansion is used for breast reconstruction, as well as for skin that has been damaged due to birth defects and injuries. A silicone balloon is inserted beneath the skin and gradually filled with salt water. This stretches the skin, which grows over time.

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Computed by Medwhy Algorithms


Source of information:
Reference: http://en.wikipedia.org/wiki/Scar
Reference: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682809.html
Reference: http://en.wikipedia.org/wiki/Old_Location
Reference: http://www.nlm.nih.gov/medlineplus/ency/article/002991.htm

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