Introduction
Children and adolescents treated with chemotherapy for cancer usually
need a central venous catheter (CVC) for medicine administration and
blood samples. The CVC is either placed in a subcutaneous tunnel with
external tubing or as a capsule located subcutaneously (port-a-cath/PAC)
on the chest. After removal of the CVC the children might develop a
hypertrophic scar or keloid formation on the skin. This tendency is
especially increased in the skin on the front of the thorax [1],
where the CVC often is located. A hypertrophic scar appears thick, hard
and red, but will in most cases fade away over several years. A keloid
formation may occur as a monstrously scar tissue that is not limited by
the normal level of the skin. The healing process can be disrupted in
one of the healing steps, e.g. at an extended inflammatory phase or
disorder in the proliferative and/or remodelling phase. This results in
a hypertrophic scar or keloid formation. Keloid can continue to grow in
size and spread to the surrounding tissue [2]. This will be
clinically evidenced by itching, pain, hypersensitivity when touched and
an increased content of vessels [2]. The formation of hypertrophic
scars and keloid occurs in 5-15 % of all wounds.
A large proportion of long-term survivors, who were previously treated
for childhood cancer including insertion of a CVC, are bothered by their
scars [3]. They describe itching and irritation and feel embarrassed
due to the scars surrounding their collarbone and chest. This causes
some patients to cover the scars and to avoid low-cut clothes [4].
Hypertrophic scars and keloid formation are difficult to treat once
formed. Injections with intralesional steroid injections preparation
with subsequent laser treatment of flushing, provides only moderately
satisfactory cosmetic results [2].
It is common practice among dermatologists to prophylactically
administer glucocorticosteroid with or without occlusion to exploit the
anti-inflammatory properties of the glucocorticosteroid hormone on wound
healing and thus try to avoid the hypertrophic scarring [5].
However, no randomized studies support this theory. A randomized
controlled trial has been performed to test the effects of use of
silicone gel sheets on children with cancer after removal of PAC. No
strong evidence was provided by the study to support the use of silicone
gel sheets after removal of PAC in children with cancer [6].
However, some clinical control studies have reported evidence that
silicone gel is effective in preventing and reducing hypertrophic
scarring [7].
The aim of this study was to test if glucocorticosteroid during patch
occlusion has a beneficial effect on scar outcome, and can prevent the
formation of hypertrophic scar / keloid in children and adolescents
after removal of a CVC.