الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Hypertrophic scars and keloids due to alteration in wound healing process at any phase are major clinical problems to dermatologists and plastic surgeons. They may develop following trauma, burn, surgery, and inflammation in susceptible individuals. The exact pathogenesis of scarring is not entirely clear; however, it seems to be the imbalance between collagen synthesis and degradation, abnormal structure of epithelium, and between fibroblastic proliferation and apoptosis may result in scarring. Intra-lesional injection of steroid is the first choice most commonly used in the clinical practice due to its efficacy and low cost, but painful injection and multiple adverse effects and recurrence may occur. Therefore, other treatment options were suggested to replace steroid or to be used in combination with it. Intense pulsed light (IPL) is the option, which is noninvasive, needs no injections with fewer side effects which are easily controlled. The exact mechanism is incompletely clear, but it most probably targets vascular proliferations essential for collagen overgrowth. Botulinum toxin type A is neurotoxin which was introduced for scars management since 2000 due to its limited side effect and its inhibitory effect on fibroblast and decreasing expression of transforming growth factor beta (TGF b) that may play a role in scarring. Furthermore, botulinum toxin seems to be involved in cell signaling during the process of scar formation. Therefore, the aim of the present study was to conduct a comparison between triple combined therapy (intense pulsed light + intra- lesional corticosteroid + intra-lesional botulinum toxin type A) and monotherapy with each component alone in treatment of hypertrophic scars. The present work included 21 patients presenting with hypertrophic scars to the outpatient clinic of dermatology and venereology department at Tanta University Hospital who were subdivided into 3 groups All patients (21 patients) received triple combined therapy in half of the scar (IPL session , intralesional steroid and intralesional botulinum toxin A ) group A (7 patients) received steroid only in the other half of the scar. group B (7 patients) received IPL only in the remaining half of the scar. group C (7 patients) received botulinum toxin A only in the other half. Patients were subjected to full history taking, general and dermatological examination, ultrasound assessment for the thickness of the scar before and after completion of treatments. Summary of our results: Regarding color, there was significant difference before and after treatment in triple group. Regarding consistency, there was significant difference before and after treatment in triple group and steroid group. Regarding pain, there was significant decrease in pain after treatment in triple group and steroid group. Regarding itching, there was significant decrease in itching after treatment in triple group and after treatment in botox, steroid and Ipl groups. There was significant decrease in thickness after treatment in triple group and after treatment in botox and steroid groups. There was significant decrease in total VSS after treatment in triple group, and after treatment in botox, steroid and Ipl groups. There was significant decrease in overall opinion regarding total patients scale after treatment in triple group, and after treatment in botox, steroid and Ipl groups. According to observer scale, there was significant decrease in overall opinion after treatment in triple group, and after treatment in botox, steroid and Ipl groups. There was no significant difference in percentage of improvement in total observer scale among the different treatment groups. According to US measures there was significant decrease in US measures after treatment in triple group, and after treatment in botox, steroid and Ipl groups.