Why you should care
Because we’d all like to live in a scarless world.
In this original weeklong series, The Plastics: The Changing Face of Cosmetic Surgery, join OZY for a guided tour at the frontiers of enhancement, from aesthetics to pain relief to power performance.
Dr. Maral Skelsey recently examined a 10-year-old girl who was extremely self-conscious — and in pain — from a scalding accident that had left a discolored burn on her leg. If the girl had been born in the ’90s, she likely would have been given a compress and steroids and sent on her way. But these days, Skelsey, the director of the Mohs Surgery Unit at the Dermatologic Surgery Center of Washington, D.C., has a battery of treatments in her arsenal. Using compression, silicone and a fractionated laser, which divides light into thousands of microscopic beams for deeper and faster healing, Skelsey was able to reduce the discoloration significantly, freeing up the girl to wear shorts and go swimming without feeling uneasy.
Skelsey’s patient is one of the 450,000 burn victims who receive treatment in U.S. emergency rooms each year — scalding is common among minors, who make up around 55 percent of all hospital-treated injuries, according to a 2016 issue of The Burns Journal. But the number of patients who now walk away pain- and scar-free is increasing as innovators develop new methods to help healing.
On the basic science level, we’re learning how to make a scarless wound.
Dr. Maral Skelsey, Dermatologic Surgery Center, Washington, D.C.
Wisconsin-based Stratatech is at the vanguard of the revolution. Its StrataGraft treatment consists of a sheet of living skin cells that is stapled over burns. Phase Three trials of the procedure, funded in part by the U.S. Army Medical Research and Materiel Command team, began in June. Perhaps sensing a winner, the U.K.-based specialty pharma outfit Mallinckrodt purchased Stratatech last year for $76 million.
A study underway at the University of Pennsylvania’s Perelman School of Medicine shows that healing cells can be turned into fat cells, which don’t produce scar tissue. In Brazil, burn victims are being dressed in strips of sterilized tilapia, while in New York, a biotech firm has developed a stem cell gun that sprays a water-based solution containing stem cells harvested from a small patch of the patient’s skin on the wound, where healing begins at the cellular level.
In sum, a mix of cosmetic and medical concerns is projected to boost the global scar-treatment market to $34.5 billion by 2025, according to Grand View Research. By comparison, in 2000 the cost of caring for children with burns in the U.S. was only about $211 million, according to the World Health Organization.
It’s an exciting time to work in wound care, but doctors and patients are quick to inject a note of realism. “There’s so much data getting published,” Skelsey says, warning that the journey from lab to end consumer can take a while. “On the basic science level, we’re learning how to make a scarless wound,” she says. “The idea is to figure out how to replicate what happens in fetal skin — that’s the holy grail for reduction of surgical scars.” The fetus is capable of regenerative healing without scars — and if that mechanism could be reproduced outside the uterus, it would be groundbreaking.
It’s a goal that Tomas Svoboda, CEO of the Swiss-German company Elanix Biotechnologies, has pursued for the past few years. Elanix’s hero product embeds progenitor cells, which can differentiate into specific types of cells, in a bioactive skin dressing. The result: healing by stimulating the patient’s body to produce new cells. Clinical trials on a gel form of the product began in Taiwan in July.
Svoboda also notes the financial benefits of such a treatment for overextended public health budgets: An intensive care unit stay for burn patients can cost $5,000 per day. With the gel, Svoboda contends, those patients could be kept in day-unit beds for $1,000 per day. “This product is proven to provide less painful healing, more flexible skin and less scarring,” he says, adding that he hopes it can offer some relief to the estimated 11 million people who suffer from burns every year.
In England, a space technology engineer and a plasma physicist joined forces to launch the Fourth State. The company’s main product is a plasma-generating pen called the Nebulaskin, which is used to smooth scars and reduce healing time. It’s currently undergoing trials at a number of British hospitals, with a burn-treatment version of the pen in the works. The pen delivers a jolt of energy to the skin, using an inert gas to protect the epidermis while stimulating subdermal plasma; the only side effect is a temporary “sunburn.” Meanwhile, South Korean scientists are combining the slimy secretions of mussels, which contain sticky amino acids, with the skin protein decorin and a collagen molecule to produce a superglue-like healing bandage that reduces scarring.
Then there’s the category of “Why didn’t we think of that first?” Scientists at Boston University have developed a hydrogel dressing that can be washed off — meaning no more painful bandage changes. And companies in Iceland and Brazil are using fish scales to treat burns — one of the projects is funded in part by the Department of Defense. It turns out that tilapia skin is chock full of collagen proteins — far more than human skin. Factor in elasticity and the material’s moisture-retaining properties, and you have the ideal wound dressing — once it’s sterilized. “I never want to be the first person to try something,” Skelsey says. “I like to wait for the data and clinical experience. But tilapia scales are pretty benign, and I wouldn’t hesitate if I’d exhausted all options.”
“War and military medicine have contributed significantly to the advancement of burn and resuscitative care due to traumatic injuries,” says dermatologist Chad Hivnor, a former U.S. Air Force physician. The San Antonio–based Hivnor, who specializes in using lasers to treat scars, believes that genomics eventually will lead to more personalized treatments, with skin sprays and stem cell therapy creating complication-free wound care — potentially scarless skin, forever. Now that’s something we can all get behind.