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.