Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children

The hypercatabolism after massive pediatric burns has been effectively treated with recombinant human growth hormone, an anabolic agent that stimulates protein synthesis and abrogates growth arrest. While experimental studies have shown increased potential for fibrosis induced by growth hormone ther...

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Bibliographic Details
Published in:	Wound repair and regeneration Vol. 12; no. 4; pp. 404 - 411
Main Authors:	De Oliveira, Gisele V., Sanford, Arthur P., Murphy, Kevin D., De Oliveira, Hermes M., Wilkins, Judy P., Wu, Xiaowu, Hawkins, Hal K., Kitten, Gregory, Chinkes, David L., Barrow, Robert E., Herndon, David N.
Format:	Journal Article
Language:	English
Published:	Oxford, UK; Malden, USA Blackwell Science Inc 01-07-2004
Subjects:	Burns - drug therapy Child Cicatrix, Hypertrophic - etiology Collagen - metabolism Female Fibrosis Growth Hormone - pharmacology Growth Hormone - therapeutic use Humans Immunohistochemistry Male Skin - drug effects Wound Healing - drug effects
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Summary:	The hypercatabolism after massive pediatric burns has been effectively treated with recombinant human growth hormone, an anabolic agent that stimulates protein synthesis and abrogates growth arrest. While experimental studies have shown increased potential for fibrosis induced by growth hormone therapy, adverse effects on human scars have not been investigated. Our aim was to evaluate hypertrophic scar formation in 62 patients randomized to receive injections of 0.05 mg/kg/day of recombinant human growth hormone or placebo, from discharge until 1 year after burn. Scar scales were used to evaluate scar‐severity at discharge, 6, 9, 12, and 18–24 months after burn, by three observers blinded to treatment. Computer‐assisted planimetry allowed quantification of percentage of hypertrophic scar formation. Types I and III collagens were localized and quantified in scars and normal skin of patients from both groups, using immunohistochemistry with confocal laser microscopy analysis. Insulin‐like growth factor‐1 blood levels helped assess compliance. Statistical analysis showed that scar hypertrophy significantly increased from 6 to 12 months after injury in both groups, while decreasing at 18–24 months postburn. Types I and III collagens were statistically increased in the reticular layer of scars from both groups when compared to paired normal skin. Insulin‐like growth factor‐1 was significantly increased in the recombinant human growth factor‐treated group. No differences were seen when recombinant human growth factor and control groups were compared using the scar scales, planimetry, or immunohistochemistry. We concluded that recombinant human growth hormone therapy did not adversely affect scar formation and should not contraindicate the administration of recombinant human growth hormone as a therapeutic approach to severely burned children.
Bibliography:	ark:/67375/WNG-6QTH5TXW-2 istex:2B9B3EB41D17ABDA2EEDFE0790F89A9732BDBEAD ArticleID:WRR12407 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 ObjectType-News-3 content type line 23
ISSN:	1067-1927 1524-475X
DOI:	10.1111/j.1067-1927.2004.012407.x