New opportunities in scar management: the role of immobilized hyaluronidase

More than half of the world’s population faces the problem of scar formation, which causes not only physical but also emotional discomfort^{[1], [2]}. There is no universal method for scar management: each clinical case requires an individualized and comprehensive approach. Modern perspectives on this issue were discussed by experts at the 14th N. O. Milanov National Congress with International Participation "Plastic Surgery, Aesthetic Medicine and Cosmetology".

The skin, which is the largest organ of the human body, is constantly exposed to external factors. Trauma, surgical interventions, and skin diseases, including acne, often lead to the formation of pathological scars. According to studies, up to 70% of surgical procedures are associated with the development of hypertrophic scars^[3], while 90% of patients with acne develop a post-acne symptom complex that includes scarring and hyperpigmentation^[4].

As noted by Larisa S. Kruglova, Doctor of Medical Sciences, Professor, Rector of the Central State Medical Academy of the Administrative Directorate of the President of the Russian Federation and Head of the Department of Dermatovenereology and Cosmetology, scars are often accompanied by itching, pain, a sensation of skin tightness, and even restricted mobility.

Modern dermatology and cosmetology offer a variety of scar correction methods, including device-based technologies, topical silicone products, intralesional corticosteroid injections, and surgical excision. However, each of these approaches has certain limitations, and the best outcomes are achieved with combination therapy.

Inflammation plays a key role in the formation of pathological scars. This process is accompanied by the production of pro-inflammatory cytokines, growth factors, and low-molecular-weight hyaluronic acid, creating favorable conditions for the transformation of fibroblasts into myofibroblasts^[5]. These cells produce excessive amounts of extracellular matrix components, including collagen, leading to the formation of fibrotic tissue, which underlies pathological scarring^[6]. An additional aggravating factor may be the formation of bacterial biofilms, which sustain the inflammatory process^[7].

Understanding these mechanisms expands the possibilities for a comprehensive approach to scar prevention and treatment. One promising tool is Imoferaza cream, which contains immobilized hyaluronidase. The product breaks down pathological scar tissue, combats biofilms, and improves tissue trophism-making scars less noticeable and reducing associated discomfort^[8].

According to Larisa S. Kruglova, the use of the cream in post-acne patients not only reduces the severity of scarring but also decreases hyperpigmentation^[9]. Positive outcomes were observed both with topical application for eight weeks and with combination approaches, including phonophoresis followed by topical use.

Long-term use of the cream (up to 40 weeks) is well tolerated and can be successfully combined with other treatment modalities, including device-based technologies. These findings were obtained in a study conducted at the cosmetology department of the Institute of Plastic Surgery and Cosmetology, Larisa S. Kruglova noted.

The accumulated real-world experience with Imoferaza cream in the management of scar-related skin deformities demonstrates its safety and efficacy as part of combination therapy, supporting recommendations for its inclusion in current clinical guidelines.

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¹Brown, B C et al. “The hidden cost of skin scars: quality of life after skin scarring.” Journal of plastic, reconstructive & aesthetic surgery : JPRAS vol. 61,9 (2008): 1049-58. doi:10.1016/j.bjps.2008.03.020.

² Amici, J M et al. “Prevalence of scars: an international epidemiological survey in adults.” Journal of the European Academy of Dermatology and Venereology : JEADV vol. 36,10 (2022): e799-e800. doi:10.1111/jdv.18277.

³Gauglitz, Gerd G et al. “Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies.” Molecular medicine (Cambridge, Mass.) vol. 17,1-2 (2011): 113-25. doi:10.2119/molmed.2009.00153.

⁴Kruglova L.S., Gryazeva N.V., Talybova A.M. Post-acne symptom complex: methods of prevention and therapy. Clinical Dermatology and Venereology. 2020;19(5):622–629 (in Russian).

⁵Loordhuswamy, Amalorpava & Santhini, Elango. (2021). Interferon Therapy for Hypertrophic Scars and Keloids. 10.5772/intechopen.96789.

⁶Adamyan LV, Pivazyan LG, Mailova KS, Peshkova YuO, Stepanian AA. Experimental modeling, prevention, and treatment of endometriosis- associated adhesion formation in NIH/3T3 fibroblast cell line using bovhyaluronidase azoximer (in vitro). Problemy Reproduktsii (Russian Journal of Human Reproduction). 2024;30(6):61–72.

⁷Allie Clinton, Tammy Carter, Chronic Wound Biofilms: Pathogenesis and Potential Therapies, Laboratory Medicine, Volume 46, Issue 4, 1 November 2015, Pages 277–284.

⁸Kruglova L.S., Ikonnikova E.V., Manturova N.E., Stenko A.G. Topical hyaluronidase: opportunities for effective use in dermatology and cosmetology. Effective Pharmacotherapy. 2024;20(1):56–60 (in Russian).

⁹Skrylova K.A., Shemuratova A.I., Khardikova S.A., Dmitruk V.S. Evaluation of the efficacy of a cream with conjugated hyaluronidase in the correction of the post-acne symptom complex. Clinical Dermatology and Venereology. 2024;23(6):753–762 (in Russian).