Talk:Scar/Archive 1

Please

I removed the following bit, it looked like vandalism to me:

Aloe plant reduces the scar's apperance. An Aloe plant is in the cactus family. If you cut a piece of plant off and sweeze the liquid out if it and apply it to the scared area two times a day for about two weeks you will see tresults; good ones! I would certainly trust any information that I found on the webcite. Everything I read about treatment of scars were true. So I'll not only take their advise but I'll run with it.

--Kasperl 10:54, 18 Sep 2004 (UTC)

Aloha, Being from Hawaii, we have used aloe for many medicinal purposes, especially burns. I fell walking upstairs and badly scraped my right shin. I didn't think much of it, but it's been 2 years, after trying all kinds of online remedies and the scar would not go away. It was shiny, and dark brown. I hated it, and wouldn't even wear shorts unless I was at home. Recently I started using vitamin E oil. In less then 2 weeks I have seen a dramatic change in the scar and the texture. It is no longer shiny, or dark brown. Of course my scar was just a surface scar, so I don't know how it would affect a deeper scar. Believe me, I am so happy now that I, myself notice a difference. I only wish that I had before and after photos to prove it to you. Let me tell the steps that I had taken to get these results. For about a week I moisterized my scar with the vitamin E oil. Maybe twice a day, but I see no harm in doing it more. After the week, I noticed that my skin was smoother and not shiny. I believe the shine in my scar was cause from being dry. I removed the top layer of skin over the scar (with a sharp needle. I used a splinter remover). After that I applied vitamin E oil and massaged it into my skin. In 2 days, OMG What a difference. I still continue to use the vitamin E oil because there is still a slight scarring. But I only see good things happening for me right now. Just to let you know, today is the first time in 2 years that I have gone out in public with my shin showing (without pantyhose, lol). Please try this remedy if you have similar scarring as mine, and I guarantee you that you WILL see a difference. Come back to this site and let know how it worked for you. Aloha —Preceding unsigned comment added by 24.25.240.148 (talk) 03:24, 19 July 2009 (UTC)

Disambiguation needed

There are other uses for the word scar, such as the songs named in the article page, as well as the villains from The Lion King and Fullmetal Alchemist. Please make a disambiguation page. --Geopgeop 09:53, 9 October 2005 (UTC)

Contradiction

This article is right now condradicting itself It says " An injury does not become a scar until the wound has completely healed." and "Note that the redness that often follows an injury to the skin is not a scar, and is in the far majority of cases not permanent." But there is a photo showing a wound that is not totally healed and is the redness of right after an injury and it says it is a scar. Which one is the accurate one? And also this article could use a photo of a scar that is a normal scar not one that's from overproducing collagen. Lyo 03:29, 11 March 2006 (UTC)

also right now parts of this article are looking suspiciously similar to a webmb.com article http://www.webmd.com/content/article/117/112615.htm It basically almost all needs to be re-written Lyo 03:36, 11 March 2006 (UTC)

entire "scars of the skin" section blatantly plagiarized from webmd. Kwalka 07:21, 15 May 2006 (UTC)

Laser Resurfacing

I'm not sure if "highly experimental" is the right term for laser treatments as they have been in use for over a decade and have in recent times shown to have remarkable results for certain scars, most notably those resulting from Acne.

Comments? —Preceding unsigned comment added by 203.184.51.24 (talk • contribs)

Request for new photo

I'd suggest choosing a new photo to illustrate this article. Using the image of a notoriously villainous Nazi to illustrate the phenomenon of facial scarring is distracting and perpetuates negative stereotypes about people with facial scars. -Steve —The preceding unsigned comment was added by 154.20.5.12 (talk) 11:57, 9 December 2006 (UTC).

yeah and a new picture or cropping the current picture to remove the genitalia would be nice toTjb891 21:46, 25 April 2007 (UTC)

My friend has a really sweet scar I'll try to get a picture of. It goes through the nipple!!! --ISeeDeadPixels 19:45, 14 May 2007 (UTC)

I've added a picture of a very conventional scar, as modeled by my arm. This is the sort of place where we should display the common or conventional forms of scarring rather than the unusual 'through the nipple' variety. ;) - --Icecold.trashcan 03:06, 2 August 2007 (UTC)

Is the photo with the dog with a scar covering a MISSING EYE really necessary? really it's quite disturbing. —Preceding unsigned comment added by 209.250.156.133 (talk) 20:05, 28 May 2008 (UTC)

Another request for new photo: Is the road rash scar picture very appropriate? It seems a bit gory. —Preceding unsigned comment added by 24.19.34.19 (talk) 05:06, 22 November 2007 (UTC)

Are the images of the C-section scar and the scar on the guy's pelvis really necessary??? I'm sorry, I know Wikipedia does not censor but I do not think we should have those photos on there unless it is absolutely necessary, and it does not seem necessary to me. Oh, and kids read this page to (I'm only 14, as you will see on my User page. Miagirljmw14 Miagirljmw_talk 23:51, 20 November 2008 (UTC)

Hi, the picture of acne scars currently being used is not a good representation. The majority of "acne scars" are atrophic scars located mostly on the cheeks but also possibly in the T zone. I do not see much if any atrophic scars in these pictures. —Preceding unsigned comment added by 209.187.72.3 (talk) 19:34, 14 May 2009 (UTC)

I have a pretty spiffy scar, should I upload? PhoenixFeather111 (talk) —Preceding unsigned comment added by PhoenixFeather111 (talk • contribs) 02:45, 15 May 2009 (UTC)

"Inappropriate"?

Could someone please explain what's inappropriate about the following? Is this a reference to the missing hyphens?

"Transforming Growth Factors (TGF) play a critical role in scar development and current research is investigating the manipulation of these TGFs for drug development to prevent scarring from the emergency (and rather inappropriate) adult wound healing process."

Thanks!

Signatorius 12:59, 7 October 2007 (UTC)

Scar Treatment

It may be appropriate to spin 'Scar Treatment' off into it's own article.

There is some conflict as to the efficacy of onion extract. The AAD seems to think that onion extract does nothing, but a Turkish group found otherwise

It would be really handy if someone summarized Topical treatments for hypertrophic scars. —Preceding unsigned comment added by 72.183.255.245 (talk) 22:50, 16 December 2007 (UTC)

A great amount of false information

This article was most certainly not written by a dermatologist, unless he was ten years behind development. Please delete the following misleading information:

"No scar can ever be completely removed." False. A single treatment tends not to remove scars completely, but treatments can be repeated multiple times to remove smaller scars. This is true especially about carbondioxide lasers.

"treatments will always leave a trace" Most treatments leave no trace at all, unless "trace" means temporary effects such as redness.

"The use of lasers on scars is an experimental treatment, the safety or effectiveness of which has not yet been proven." How can you call it "experimental treatment", if virtually EVERY dermatologist recommends it? Virtually EVERY dermatologist guarantees its safety, and the same degree of effectiveness can be achieved as with any archaic treatment. At least this is the case where I live, in Scandinavia. 84.250.123.208 (talk) 13:22, 10 April 2008 (UTC)weuselaserinthe21stcentury

Also, what about it saying every injury causes some degree of scarring, I thought bones that heal don't cause scarring. And it only talks about scars forming when the dermis is damage, but what about others tissues than skin? Muscle, fat and the liver to name a few, and the liver has the ability to regenerate, so would it scar? The snare (talk) 01:11, 26 September 2008 (UTC)

Road Rash Scar Image

It's a little misleading; the images do not run chronologically from left to right, but from right to left. At least I think so. Unless the scarring is much, much worse than the original injury! Petitphoque (talk) 19:06, 1 May 2008 (UTC)

Non-neutral point of view

Drawnedlac (talk) 18:57, 15 June 2009 (UTC) removed the text below due to it's non-neutral point of view, it also seems to take a step over the line of product bias which is non-verifiable.

UltraPulse Fractional ActiveFX and DeepFX Laser Scar Treatments combine to bring a new scar treatment modality that can resolve color abnormalities, improve texture inconsistencies, all with reduced down time and increased patient comfort.

With ActiveFX treatments, the laser treats mostly the surface of the scar. The laser beam is applied in a fractional pattern leaving intact "bridges" of untouched skin to quicken the healing process. This results in new skin generation where color changes in the scar can be evened out and texture improved.

DeepFX is a treatment which goes deeper in the scar. By going deeper, the treatment initiates a healing response that promotes a more organized collagen structure representing more normal skin [citation needed]. This evens out the surface texture and smoothness of the skin [citation needed]. The DeepFX treatment is also applied in a fractional pattern leaving intact "bridges" of untouched skin to quicken the healing process.

Banana treatment

I've read on many sites that banana can help in scar healing. Check this site for example http://www.mamaherb.com/scars-home-remedy-using-banana. It seems that you can heal it pretty fast. —Preceding unsigned comment added by 178.223.50.124 (talk) 22:10, 22 September 2010 (UTC)

No scientific evidence. It may work to keep the scar hydrated, but so does lotion. Rknight (talk) 07:56, 25 March 2011 (UTC)

Internal tissue scarring

Since this article focuses on dermatological tissue scarring, do we have a page that deals with scarring of internal tissues?? If yes, where? Thks. 76.97.245.5 (talk) 16:32, 18 March 2009 (UTC)

Recent edits: bee venom; scar-free healing

The following was copied from User:ImperfectlyInformed's talk page.

Hello ImperfectlyInformed

I undid your revisions on scar but I reedited to take in your concerns.

I notified that bee venom therapy is alternative (it has evidence presented) & that the Moss and Clifford claim was a patent, and this work was not peer reviewed. This makes the facts even more valid and fair game. The cites are not making any claim that claim anything other than what the facts present.

• The cites present the fact that the bee venom has the label alternative, and the scar free healing is not peer reviewed and is a patent, there is no twisting, no bias towards the alternative, no bias towards the patent and no bias towards the what me or you or anyone regard as orthodox. This is interesting encyclopedic knowledge that a reader should read to get a critical and thorough view regarding the topic scar. The reader can now see the and inform himself that the Bee venom is alternative, that the Moss & Clifford work was a patent that was not peer reviewed. Just like he can inform himself with other things in the article.

I respect your view, but as far as I know Wikipedia, is a freely usable public encyclopedia that does not appeal to a subjective authority in what is cited (you mentioned peer reviewed on the Moss and Clifford cite, therefore you took it down). As far as I know Wikipedia is a public resource that does not show bias to any anything you, I or anyone regards as authority as long as the facts are completely valid, not twisted that can be attributed to the article in matter.

There are no facts twisted here, and the reedits to my view are wrote with nothing missleading, no bias, no favor and no malice to anyone. Do you agree? And do you agree they are valid?

--->>>> I probably should have noted you I was going to redit before I did, but it is done now. —Preceding unsigned comment added by Veryvery20 (talk • contribs) 20:34, 29 August 2010 (UTC)

You can sign your comments by adding four tildes after the comment (~~~~). While I appreciate your response, Wikipedia has certain policies including reliable sources and verifiability, and for medicine in particular there's a standard at WP:MEDRS. We want Wikipedia to be trustworthy and accurate, and I don't think these things meet that accuracy level. Please read those policies and respond; if you still think these things need to be included we can discuss further. On bee venom, has anyone published any careful case studies? Has there been any follow-up on Moss & Clifford's patent, and how did you find this "scar-free healing" information? Do you really think Moss & Clifford's method works? II | (t - c) 20:43, 29 August 2010 (UTC)

Hello again ImperfectlyInformed

I found this Moss & Clifford scar free healing information on page one of google. The last time I checked it was on page two, probably on page three now...

Regarding the bee venom, I do not know. But IMO that is not the point, it is obvious it is alternative.

I'm very uncomfortable removing valid verified sourced information from anything and having a bias to what we are told what is (IMO you should be too), it feels like a version book burning and suppression to me, it always smells manipulating and fishy what ever it is; especially if the fact is accurately validated by what is said in the text, and then put in a context that is trustworthy and not twisted. Which IMO this is very very trustworthy, water tight trustworthy, water tight because the two pieces do not make a claim to be anything other than alternative or a patent that 'claims' scar free healing that was not peer reviewed.

Anyway what if the bee venom therapy works (BTW it looks like it has on the case with the image links provided), but no one would be able to inform themselves because it has been took off wiki and then put to page 35 on google etc. I find that absurd, a complete waste of valuable encyclopaedic information.

Regarding the Moss and Clifford patent, I find the information has equal merit to anything else if it is not twisted to do with the topic. Do I think the claim works? I do not know. But his claim has equal merit to anyone elses no matter what influence or position they are perceived in society. But again that is not the meat of the point. I like it not twisted and accurately referenced for free speech, freedom of information but more importantly for encyclopedic purposes that they have claimed it has worked, I have no qualms if anyone critiqued the claim too, as I myself might get/have got around to balancing it more. And I would like some one to compare it to any other individual or group that in the future claims scar free healing.

There is to much fog here and to much, he says that is authorative and he says that is not IMO.

Regarding what I propose should be done here

IMO the Treatment section should be split to how many sections it needs. Instead of putting the alternative bee venom treatment under Treatments, put it under Alternative Treatments, the patent under Treatments, put it under Patented Claims For Treatments etc.

What do you think?

My regards.Veryvery20 (talk) 22:00, 29 August 2010 (UTC)

I'm going through and looking to update citations; I'm going to remove citations that make medical claims but aren't a scientific publication. If I can't find a reasonable trial supporting a treatment, I'm going to remove that treatment. Rknight (talk) 16:40, 24 March 2011 (UTC)

RKnight

Look please do not tell me or anyone how to edit a public resource.

Also please do not put your authority to what is or what is not dangerous. We are not an arbitary authority as to what is or not is dangerous.

E.g. I once gave someone direction to shelter. The hotel was accross a busy road. Does this mean because I gave someone information that the messenger would be to blame if that person got ran over in that scenario crossing the main road to shelter?

You are blaming the messenger and you are also sensationalising for some reason.

You have no logic to remove anything as to what YOU decide is dangerous with your subjective filters.

This logic is the same with bee venom, we are nort nannies, we do not suppress what people can or cannot see. Also if you think this is dangerous from your POV, then apply a cite that adds a bit of critical balance and shows it is dangerous, instead of book burning and suppressing encyclopedic knowledge.

BTW this is an encyclopedia NOT a marketing exercise. Encyclopedic validated facts stand. Now if you dont like something encyclopedic written, well instead of book burning please write something that highlights a problem, then cite this premise that highlights a problem.

E.g. with Bee Venom, you could write something like, Bee venom therapy gives scar free healing [insert the valid citation from Dr Jones of the Jam corporation]. However the application of Bee venom is dangerous as it gives you green spots [insert cite by Dr Smith of the Backlog corporation you fished out]

Regarding Ace inhibitors you assume that this is suggesting it is a treatment being used. IT does nothing of that sort it says what the cite does on the tin. Which ace inhibitors brought scar free healing in an experimental setting. Look at the quotes.

Both these cites are going back up as they are valid.

Now if you dont like them instead of spinning, write an encyclopedic critique with citations that balance the knowledge out.

Insead of suppressing fact by spin and deletion, I say bring in other encyclopedic facts that add a bit of encyclopedic critique. — Preceding unsigned comment added by Veryvery20 (talk • contribs) 15:48, 9 April 2011 (UTC)

VeryVery, your edits are clearly Wikipedia:Fringe_theories and the sources do not conform to the Wikipedia:Reliable_sources_(medicine-related_articles). The proper place to discuss adding disputed sections is on this Talk page. If you cannot reach a general consensus here, and you feel that strongly about it, you may request the Wikipedia:Mediation_Committee/Policy decide one way or another; I will abide by their decision. If you continue to revert in contravention of Wikipedia Policy, you will be reported on the Wikipedia:Administrators'_noticeboard/Incidents. Regards, Rknight (talk) 00:38, 10 April 2011 (UTC)

Fringe theories, . That is ludicrous. Please stop chucking labels around that do not fit. You've started ridiculously chucking labels around and are trying to now point to policy instead of discussing this.

"Claims must be based upon independent reliable sources. An idea that is not broadly supported by scholarship in its field must not be given undue weight in an article about a mainstream idea,[3]" http://en.wikipedia.org/w/index.php?title=Wikipedia:Fringe_theories&oldid=421659848

"Fringe theory in a nutshell: To maintain a neutral point of view, an idea that is not broadly supported by scholarship in its field must not be given undue weight in an article about a mainstream idea. More extensive treatment should be reserved for an article about the idea, which must meet the test of notability. " http://en.wikipedia.org/w/index.php?title=Wikipedia:Fringe_theories&oldid=421659848

And if you are trying to aplly me as a fringe theorist, I laugh at that as my politics is probably middle ground.

Now please tell me were any undue weight has been applied. And please tell me were the claims are not independant?

You have pulled that out of thing air and then tried to pin the tail on the donkey blinfloded with your filters.

Look at the Ace inhibitors cites.

An Ace inhibitor Enalapril at a low dose, over a set period, has been shown inhibit to resolve hypertrophic scarring completely and reduce keloid scarring. Another ace inhibitor, a 5% Captopril solution has also been shown to reduce the fibrotic tissue in keloids.

(BTW>>>> this new validated premise here is a new cite put in that you have conveniently ignored, which adds even more independant weight to the Ace inhibitor discussion) An ace inhibitor called Losartan has reversed fibrosis in end stage liver disease in a small study.

Ace inhibitors inhibit, suppress or kill myofibroblast activity.

The above is what has been written.

Here are the citations from the above so anyone can check tyhem:

• "Low-Dose Enalapril in the Treatment of Surgical Cutaneous Hypertrophic Scar and Keloid - Two Case Reports and Literature Review". Pubmed. March 2009. Retrieved 2010-10-28. In the meantime, the patient was treated for mild arterial hypertension with low-dose enalapril (10 mg, once a day), coupled with a very low dose of hydrochlorothiazide (3 mg, once a day), administered in the morning. After 15 days of this treatment, the keloid scar dramatically improved, with a nearly complete recovery.

• "Low-Dose Enalapril in the Treatment of Surgical Cutaneous Hypertrophic Scar and Keloid - Two Case Reports and Literature Review". Pubmed. March 2009. Retrieved 2010-10-28. In the meantime, the patient was treated for mild arterial hypertension with low-dose enalapril (10 mg, once a day), coupled with a very low dose of hydrochlorothiazide (3 mg, once a day), administered in the morning. After 15 days of this treatment, the keloid scar dramatically improved, with a nearly complete recovery.

• accessdate = 2010-10-28 "Low-Dose Enalapril in the Treatment of Surgical Cutaneous Hypertrophic Scar and Keloid - Two Case Reports". Department of “Medicina Interna e Patologie Sistemiche,” University of Catania Medical School, Garibaldi Hospital, Catania, Italy;. Moreover, the old hypertrophic scar (due to cesarean sections) completely disappeared after 3-4 months of enalapril treatment.and Literature Review {{cite web}}: Check |url= value (help); Missing pipe in: |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: extra punctuation (link)

• "Treatment of a Postburn Keloid Scar with Topical Captopril: Report of the First Case Sir:" (PDF). Plastic and Reconstructive Surgery. March 2009. Retrieved 2010-10-28. with 5% captopril solution in cold cream. After 6 weeks of twice-daily application of the cream, a marked improvement of the keloid lesion was achieved as the height of the lesion decreased from 9 to 11 mm to 2 to 4 mm, the redness and scaling were noticeably eliminated, and she has not complained of itchiness (Fig. 1, below).

• "Liver Disease 'Shrunk' By Blood-pressure Drug". 2009-06-02. Retrieved 2011-04-09. {{cite web}}: Text "quote the drug blocκs the signalling pathway so that the liver myofibroblasts die, removing the source of scar tissue. As the scar tissue breaκs up, the damaged area of the liver is repaired by the body." ignored (help)</

There are independant reports from 3 or four sources, University of Catania Medical School, Garibaldi Hospital, another university, and the latest one you have ignored there is another 3rd or 4th University study which showed that ace inyhibitors killed myofibroblast activity and also removed scar from a late stage liver disease, which completely backs up everything said before on an independant scope, everything also fits in with the fact that myofibroblasts create scar tissue and they reinforce the knowledge by showing via various studies that scarring has been reduced down to the fact that ace inhibitors reduce scar by suppressing or killing myofibroblast activity., Also the various independant Dr's here have more authority on this subject than your POV. Also if you look at what has been wrote in not one instance has undue weight been applied.

"Fringe theory in a nutshell: To maintain a neutral point of view, an idea that is not broadly supported by scholarship in its field must not be given undue weight in an article about a mainstream idea. More extensive treatment should be reserved for an article about the idea, which must meet the test of notability. "

http://en.wikipedia.org/w/index.php?title=Wikipedia:Fringe_theories&oldid=421659848

Show me were any undue weight has been applied, and show me were this is not independant (by implying this is fringe theory you have claimed undue weight has been applied and that these studies are not independant).

If you look 1. nothing makes any claim that the cites dont claim, and 2. nothing makes any claim outside of the myofbroblast knowledge that is in the article. 3. All of these sites are independant.

I'll get onto the bee venom article later. But my theory here is you have deliberately attatched the bee venom piece to this Acw Inhibitor piece, when they are chalk and cheese but equally valid. (e.g. Someone ignorant could assume the bee venom piece is fringe, therefor if that is attatched to the Ace inhibitor bit they may assume the ace inhibitor is fringe? Yet the ace inhibtor bit is mainstream, there has been expensive and logical research that shows and highlights ace inhibitors reverse scar)

We should approach both ssubjects the bee venom and ace inhibitors seperately as they are two seperate pieces. They are not associated like I assume you may want them to be or you want people to assume they are.

Now as you are trying to push POV authority and OWNERSHIP of the article I'm going to reinsert these perfectly valid cites.

And stealing and paraphrasing your words (as this type of point to authority can work both ways)

I'm reverting the valid cites now if you cannot reach a general consensus here, and you feel that strongly about it, you may request the Wikipedia:Mediation_Committee/Policy decide one way or another; I will abide by their decision. If you continue to revert in contravention of Wikipedia Policy, you will be reported on the Wikipedia:Administrators'_noticeboard/Incidents. Regards,

VeryVery20 --Veryvery20 (talk) 13:00, 10 April 2011 (UTC)

VeryVery, one last chance before I ask for intervention. Please stop editing the main page until we've reached a consensus here. This is exactly what the talk pages are for. If you wish to consider ACE Inhibitors and Bee Venom separately, please feel free to create a new section on the Talk page.

The sources you cite for ACE Inhibitors are all case reports. 7 cases. As per Wikipedia:Reliable_sources_(medicine-related_articles)#Assess_evidence_quality, "Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources." Your last source is about liver fibrosis in hepatitis C; and this wiki page is about dermal scarring. I don't think anyone would be able to confidently apply knowledge from one to the other.

Again, please stop adding Bee Venom back to the main page. Throw up some reliable sources on here, and we'll reach a consensus on whether to add it. Rknight (talk) 04:15, 11 April 2011 (UTC)

I agree with Rknight. Thanks for stepping in to help. I kind of gave up on getting the page into line after a couple reverts, but with an person to help I think we can keep this page up to standards. II | (t - c) 04:57, 11 April 2011 (UTC)

I made an edit adding back Centella asiatica in combination with microporous tape, which was removed along with some bark extract experimental stuff. Centella asiatica has had some promising animal results for a long time now, but in the past couple years there's been some just as promising clinical research. I added the clinical trial; you can also see more photos at Widgerow's page, and altho I added a review article, Widgerow has authored a couple reviews in more mainstream journals as well (see http://dx.doi.org/10.1111/j.1524-475X.2010.00662.x and http://www.springerlink.com/content/u668228642np843w/). Widgerow is selling his innovation in South Africa under the name "Scarscience", but I've used a similar product containing Centella asiatica which is sold in the US as Scartini. The results are pretty remarkable. II | (t - c) 06:09, 11 April 2011 (UTC)

It's an interesting study, II, but certainly preliminary. I'm always hesitant about studies funded and performed by people who have a fiscal stake in the success of the treatment. That said, it looks like solid research. My criticism is that it's not a head to head comparative with silicone. Rknight (talk) 17:41, 11 April 2011 (UTC)

RKnight, The wiki page is about scarring, (not just dermal scarring) liver fibrosis IS SCARRING. BTW Why are you trying to hide information???--Veryvery20 (talk) 11:00, 11 April 2011 (UTC)

Veryvery, all the treatments on the Scar page cover dermal. I don't really care to start cluttering things up with information that has it's own place; namely, Cirrhosis. Perhaps we need to have a discussion about which information belongs where. Rknight (talk) 17:41, 11 April 2011 (UTC)

Ace Inhibitors

Rk Knight is IMO trying hide information about Ace inhibitors in the scar article... Here is the recent piece he has pulled out people:

ACE inhibitors block the conversion of angiotensin I to angiotensin II. The increase of angiotensin II increases expression of α-smooth muscle actin (α-SMA) and myofibroblast proliferation. (<<-- BTW if you read the article myofibroblast proliferation is implicated in scarring)

An Ace inhibitor Enalapril at a low dose, over a set period, has been shown inhibit to resolve hypertrophic scarring completely and reduce keloid scarring. Another ace inhibitor, a 5% Captopril solution has also been shown to reduce the fibrotic tissue in keloids. An ace inhibitor called Losartan has reversed fibrosis in end stage liver disease in a small study. Another major independent study across Europe is underway.'''''

Ace inhibitors inhibit, suppress or kill myofibroblast activity.

He has also accused me of putting undue weight and not of using independant sources.

SERIOUSLY 1. IS THERE ANYTHING IN THERE THAT HAS UNDUE WEIGHT?

2. IS THERE ANYTHING IN THERE THAT DOESN'T HAVE INDEPENDANT SOURCES.

3. ALSO AS THERE IS NO UNDUE WEIGHT, IS THERE ANYTHING IN THEIR THAT IS DANGEROUS?

4. WHY ARE YOU TRYING TO ATTACH THIS TO THE BEE VENOM PIECE (WHICH IMO IS EQUALLY VALID, BUT I CAN SEE SOME IGNORANT PEOPLE MIGHT KNEE JERK AT IT) As you can see the cites are correct and valid and it is probably one of the safest written pieces in the article.

So why are you trying to suppress rthis using inaccurate finger pointing with association RKnight?

I'm not at all happy about this.

BTW regarding the above I know it looks like I'm shouting but I'm not (just regard thos as highlighting, I need the attention here because he is continuing to point and he is ignoring this), I just want this addressed. It seems he is pointing the finger and not correctly addressing the concerns about this finger pointing.--Veryvery20 (talk) 11:04, 11 April 2011 (UTC)

A rewrite

A rewrite of how the Ace Inhibitor piece should look, which added phrasing identifying who is using this treatment plus rephrasing some for clarity, what do you think? (This should fit RKnights criteria http://en.wikipedia.org/w/index.php?title=Scar&action=historysubmit&diff=423471133&oldid=423467587)

ACE inhibitors block the conversion of angiotensin I to angiotensin II. The increase of angiotensin II increases expression of α-smooth muscle actin (α-SMA) and myofibroblast proliferation.

A 2006 study by Iannello et al at the University of Catania Medical School, Garibaldi Hospital, Catania, Italy has found has found that an Ace inhibitor Enalapril at a low dose, over a set period, has been shown inhibit to resolve hypertrophic scarring completely and reduce keloid scarring. More independent research by Ardekani, from Jahrom University of Medical Sciences found another ace inhibitor, a 5% Captopril solution has also been shown to reduce the fibrotic tissue in keloids. In 2009 a study found an ace inhibitor called Losartan has reversed fibrosis in end stage liver disease in a small study. Another major independent study across Europe is underway.'''''

Ace inhibitors work by inhibiting, suppressing or killing myofibroblast activity.--Veryvery20 (talk) 11:50, 11 April 2011 (UTC)

VeryVery, you are quoting from the parts of your sources that support your position, and ignoring the conclusions of the study authors. I'm going to quote the summary from your primary source, Low-Dose Enalapril in the Treatment of Surgical Cutaneous Hypertrophic Scar and Keloid - Two Case Reports and Literature Review and italicize the reasons why the Scar wiki page should not accept ACE inhibitor treatment as fact.

On the basis of the fortuitous observation of a beneficial effect of enalapril on recent and long-standing postsurgical keloid scars and confirmatory data from the literature, ACE inhibitors and angiotensin-receptor antagonists (largely used in clinical practice) should be regarded as potentially useful therapeutic agents for patients with fibrotic diseases (such as lung fibrosis and postinfarction left ventricular remodeling) and, perhaps, also for healing bad cutaneous scars and repairing tissue.

Obviously, our observation is only a preliminary one, and our results should be compared to those observed with similar keloids not treated with enalapril.

During the posttraumatic or postoperative stage, it is difficult to achieve the best possible aesthetic when treating cutaneous scars. The proliferative phase occurs during the first few months, and pharmaceutical intervention can help to decrease the risk of aesthetically disfiguring hypertrophic or keloid scars, thereby avoiding revision surgery. Furthermore, surgically removed keloids commonly recur within the excision sites. Therefore, the precocious treatment with low-dose enalapril, which is not associated with side effects (except in patients with acute renal failure or chronic renal insufficiency and those with collagen vascular disease), is a possible solution; however, further confirmatory observations are needed. Rknight (talk) 02:57, 12 April 2011 (UTC)

RKnight you have strawmaned the position and you are twisting the premise, also you have ignored other parts that strengthen this cite which BTW is strong enough and notable enough, to stand by itself..

Your strawman, here is the original premise (paraphrasing): In the year 20XX using a drug scar regeneration was noted by a Dr at some burns unit somewhere on earth Before we go on again here is the non twisted original validation (the cite and paraphrasing again, which BTW was actually exactly quoted like it said in the real citation in, but below it is paraphrased for purely a demonstration): Quote “In this text these Dr’s have noted a regeneration by using this substance. “ Some Dr Some University Hospital somewhere on earth.

Tell me above what is twisted in that? As you can see if you verify correctly, it is nothing. There is no lie in that there is actually no exaggeration. It is all valid and says what it means to say.

Now on to your strawman premise twist. Rk your twist suggests conclusions. Now were in that premise that is validated does it go onto anything about conclusions of the study? As you can see the answer is nothing. Now if you want the conclusion written in, then adjust the text and note the conclusion with a citation and then you can play a part in strengthening the encyclopaedic knowledge in the article. Anyway I hope you don’t think I’m being unduely confrontational here but from the above can you see how you have strawmanned the position of what has been written and used it as an excuse to take down perfectly cited material? Any way going on, lets say your concern was valid (and you did not strawman what has been wrote) Staying on to your concerns though. In your final bottom line you have highlighted, “further confirmatory observations are needed.” If you look at others and experimental in the article you can see quite clearly, “further confirmatory observations are needed.” Are you suggesting at all that it should be moved to the Other & experimental section with other stuff that needs confirmatory observations?

Ignoring of the context. Rknight, IMO it is clear as anything that the citation you have hand picked is notable and can stand on its own two legs. But lets say it wasn’t. Then you have completely ignored all the other citations which are interlinked which back it up so it can stand by connection. E.g lets look elsewhere in the article first. If you look at the myofibroblast is implicated in scarring. This gives a quality background foundation to any cites that are written about drugs or mechanisms that suppress inhibit or kill myofibroblasts. IMO it is clear you have ignored the myofibroblast knowledge. Now lets look at the Ace inhibitors piece. There is knowledge in there that is cited, that shows Ace inhibitors suppress myofibroblasts giving the ace inhibitor piece a reinforced sturdy foundation etc. In hand picking your point you have ignored that. In your point you pick up one study you pick out on citation to pull down the whole piece. You completely ignore the other stuff which back that piece you have a problem with. E.g. In the piece there is a second citation about how scarring is reduced over a six week period. And there is another piece that shows how scarring has been removed in end stage liver disease and how there is a European wide study looking into this. Can you see your selection process?--Veryvery20 (talk) 11:53, 12 April 2011 (UTC)

VeryVery, your constant ad hominem attacks make your blocks of text really hard to read. You might want to practice conciseness. Regardless, all your citations are case studies. Again, from Wikipedia:Reliable_sources_(medicine-related_articles)#Assess_evidence_quality, "Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources." I don't think you can make a special case for these case reports, simply because the authors are hesitant to make claims. I would need to see some randomized controlled trials before listing something under experimental, and a review article prior to moving something into the list of established treatments.

I've been ignoring the myofibroblast stuff because it's not applicable to a given treatment actually working. In vitro and animal studies may suggest something, but don't necessarily translate to human therapeutics.

Your last point, treatment of Cirrhosis, does not belong on the Scar page. Until we see a scholarly article establishing equivalence between dermal scarring and liver scarring, we can only assume that they are two different concepts. (Especially given that a drug treatment of cirrhosis could mean that the drug is a precursor which only gets converted to the active compound within the liver, and doesn't escape. Such a scenario is easy to imagine because it occurs often, and means that the drug only affects the liver, and not other tissue.)

I'm fully willing to believe ACE Inhibitors can treat dermal scarring. The only reason I removed it was because, when I went through checking, updating, and adding citations, I only found case studies. Rknight (talk) 18:38, 12 April 2011 (UTC)

Anyway, I think we're going around and around. I need to see a RCT before I'm okay with placing ACE Inhibitors under the experimental treatments section, and a secondary source before calling it a real treatment. I think the next step is to allow 3rd parties to chime in. Fellow editors? Rknight (talk) 18:38, 12 April 2011 (UTC)

In response to Rknight's request: this is content that does not currently belong in the article. I think everyone needs to have a close look at WP:MEDRS, the guideline for reliable medical sources. Small studies that have not yet shown major differences in hard endpoints are really not suitable for inclusion. Ideally, we need a "secondary source" (a high-quality review in a major journal) to support such content. These rules prevent Wikipedia from turning into a grab-bag of poorly tested theories and treatments. JFW | T@lk 21:25, 12 April 2011 (UTC)

Good afternoon,

It can be difficult as an editor coming in for the first time to a long discussion such as this, but without taking it off of the WK:3O list, I personally would consider:

1. The mutually accepted overall reliability of the article at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868346/

2. Whether you can come to an agreement as to how this information might be incorporated in to the article.

There were only 2 people in this trial if-you-will, but the article goes on to say:

"..confirmatory data from the literature, ACE inhibitors and angiotensin-receptor antagonists (largely used in clinical practice) should be regarded as potentially useful therapeutic agents for patients with fibrotic diseases (such as lung fibrosis and postinfarction left ventricular remodeling) and, perhaps, also for healing bad cutaneous scars and repairing tissue."

Based on that, What about starting a section that discusses, "Potentially beneficial treatments"? or "Treatment methods that may have promise after further study(ies)", For example,

Treatments that have not made it to Clinical Trials but may have merit after further testing/trials are as follows:

• ACE Inhibitors that......
• Some other healing agent.
• Some other healing agent, etc.

It gets the information in to the article, but does not commit to, or take away from, the integrity of the article or Wikipedia. This is just a suggestion, as I was led here after entering my own debate with an editor! Best wishes and,

good luck with this.. Dijcks HotTub Pool 23:03, 12 April 2011 (UTC)

Rknight, where have i ad homined you in that piece i wrote. Where have I called you a name? WHERE? Show me? Show me. Have I took the p out of the way you look, have I took the p out of your English grammar instead of looking at your argument etc.? 1.i addressed your argument and your strawman completely. I also highlighted how the original premise was valid. 2.I also highlighted were you twisted the original premise (were you tried to make it look like I twisted something about the conclusion of the study, when I did not mention the conclusion) 3.I also suggested if you have a problem with the conclusion then to write in a note that highlights the conclusion of the study.

Rknight you are the only one relying on AND actually using fallacious arguments (1. you point to authority, 2. you have strawmanned a premise, 3. you have guilt associated a studied treatment to an alternative treatment as you know some people knee jerk at alternative treatments, and 4. BTW you have accused me of an ad hominem attack on you and in that sentence you then say you can’t understand my English. 5 You try to distract from a simple argument. 6 You try to make this argument seem complex when it is not). BTW if you look at my argument I don’t need to use any fallacious tactics. I actually do not need to use them. WHY? Because I do not have to make an excuse for taking something away.

The outline of my argument is simple. All I have to do is focus on the argument at hand and in essence I am defending a simple premise with a simple citation (a citation that is not twisted BTW) that exactly describes and validates the simple premise. This imo is easy especially when all the citations of these studies are notable and reliable. Not only are the premises reliable they are backed up by other studies.

Seriously, I’m paraphrasing here: what is complex about

A notable Dr at a burns University noted after using some substance that he regenerated tissue [validated with a reliable citation that describes exactly what he did.] Further more another notable Dr noted that regeneration happened with another substance from the same family. [reliable citation inserted that shows exactly what was said] Even more studies have implicated the substance removes scars on tissues[citation which again is 100% verifiable]. This substance seems to work by inhibiting myofibroblast proliferation [verifiable in the article].

Another note to RKnight, The article is about scarring not just dermal scarring, its about scarring. And If you look at the article you can see quite clearly that scarring is the result of excess collagen production on ‘tissues.’

Dijcks HotTub Pool Regarding your points 1.There is actually nothing wrong with the citation. It is notable and IMO this is clearly OK to put in the article IMO would ncbi.nlm.nih.gov put this http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1868346/ if it wasn’t reliable? 2. “Whether you can come to an agreement as to how this information might be incorporated in to the article.” Regarding number 2 Diicks HotTub Pool I’m working for exactly that consistently. All I say is lets keep it encyclopedic; encyclopedic enough for views on all sides.

And your further suggestion of a new sub-sections is a fair compromise IMO

Rknight so how about a new section called something similar to: Treatment methods that may have promise after further study(ies). As Dijks HotTub Pool suggested.(http://en.wikipedia.org/w/index.php?title=Talk%3AScar&action=historysubmit&diff=423765627&oldid=423765222)

What do you say?

IMO this addresses your concerns and addresses my concerns of this being taken out?--Veryvery20 (talk) 11:17, 13 April 2011 (UTC)

Well, all I can say is, "good luck" with it you guys! I can fully understand how these debates can run hot. On my end, I had some good neutral advice, mixed with a bit of criticism, and then some good direction, and plan to put it to use. It's also important to note that I am not taking sides, I'm simply offering a idea for compromise.

If I've learned anything here at Wikipedia, you need

• Patience
• Understanding
• Integrity
• Compassion
• A think Skin

One thing about insertion of this particular content at issue is, Wikipedia is a trusted reference for many researchers, and the insertion of recent "cutting-edge" or new technologies ~ IMPORTANTLY, the text thereof properly cited, and qualified, IMO raises the quality and integrity of Wikipedia.

Consider: Where would "Viagra" be had it not been a failed Blood Pressure Medication Trial? Imagine if editors at Wikipedia were first to evidence this fact?

That said, I represent just ONE view.

IN CLOSE: I would consider that Wikipedia is a non-paid, self-inflicted position, that we love so much!, and compromise IS your friend. Dijcks HotTub Pool 16:24, 13 April 2011 (UTC)

VeryVery, I am not going to respond to your sophistry, merely your claims. This is what I'm not compromising on:

• Articles involving cirrhosis do not belong on this page, they belong under Cirrhosis. If you wish, you may mention liver scarring and link to the Cirrhosis page. This page, Scar is what people come to when they have a dermal scar, and they will be looking for recommendations to use silicone sheeting, say, not that they should stop drinking.

• On this page, we follow the policy in WP:MEDRS. Exceptions to the policy may be made, but only with 'very' good reason, and with broad consensus among editors.
  • Secondary sources such as review articles will be presented as the scientific consensus.
    • "All Wikipedia articles should be based on reliable, published secondary sources."
    • "The best evidence comes from meta-analyses of randomized controlled trials (RCTs) and systematic reviews of bodies of literature of overall good quality and consistency addressing the specific recommendation."
  • I am perfectly willing to consider primary sources on a case-by-case basis; certainly large, well-designed RCTs bear mentioning, as do in-vivo results that support the general scientific consensus.
    • "Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse."
    • "Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources,"
  • Smaller RCTs I'm a little less enthusiastic about, but I don't mind mentioning them with the caveat that they are experimental, but represent the current direction of research. If they get too old without further study, though, I think we can safely assume that people tried and failed to get positive results, and they should be removed.
    • "If no review on the subject is published in a reasonable amount of time, the text associated with the primary source should be removed."
    • "For example, the results of an early-stage clinical trial are unlikely to be appropriate for inclusion in the Treatment section of an article about a disease because a possible future treatment has little bearing on current treatment practice."
  • Any clinical study less than stage II, case reports, and in vitro results that do not support a more definitive RCT have no place in an encyclopedic resource.
    • "Case reports, whether in the popular press or a peer reviewed medical journal, are a form of anecdote and generally fall below the minimum requirements of reliable medical sources."
    • "However, the results might—in some cases—be appropriate for inclusion in an article dedicated to the treatment in question or to the researchers or businesses involved in it."

Dijcks, I completely agree. However, the standard of treatment comes from review papers. Cutting-edge research will be found in stage III clinical trials. Bleeding edge experimental research will be found in stage II trials. And that's all I'm comfortable listing. Stage II is where they determine if the treatment works (although they don't compare how 'well' it works) and where they get a good grasp on side effects. Many if not most treatments don't get further than this, and this is where I'm drawing the line as far as notability goes, since knowledge of these these treatments is only useful in determining the direction research is going in. Rknight (talk) 20:01, 13 April 2011 (UTC)

Dijks you mention Viagra in how it found other uses… That type of thinking is in my somewhere in my mind too. E.g. what if this piece of information gets hidden, and does not see much daylight. And no one ever thought about looking into it.

Rknight

The article is about scarring (fibrosis). Scarring eventually affects every wounded soft tissue in the body, liver lungs, skin etc. Dermal scarring perhaps should have its own page IMO.

Before I begin, here is what I regard as a public encyclopaedia. So you can see where I come from.

A public encyclopaedia is a rich knowledge base of fairly cited information that consistently balances over time.

What is the encyclopaedic subject: Picture a square, inside that square is a hundred pieces. IMO every aspect of those pieces that are connected is the subject at hand and gives the subject its encyclopaedic richness of color and foundation, the squares can represent history, theories, hypothesis, understandings, even eccentric quirks if they fit in the scope of the article. No square should be suppressed by any facet of society. Nothing should be suppressed and everything should be faced. (IMO in human nature suppression or ignorance leads to some sort of hyper frenzy of some kind revolving around a problem paradigm of thought or belief. For a while this tends to reduce anything healthy that challenges a school of thought until the tipping point) Also avoidance in life generally does not solve the problem, e.g. how many people in the future from their position in society, will read the history of wiki and be offended at what they perceived has been suppressed and avoided? Everyone is better off facing it.

At the same time though everything must be verified no cite must be twisted and all twisted citations should be weeded out; the most important aspect of an encyclopaedia is everything must be balanced to encompass and freely critique all views, after all this is a public resource and not everyone agrees.

So how any public encyclopaedic page should evolve. .. Every facet of society should be able to have a go at the articles evolving destiny. The article itself should be freely grown… it should gain richness as time goes by e.g. images are added and add detail, graphical images emerge, new sub titles emerge etc. Regarding the scar article for instance, let’s say in 3 years from now the history of treatments is a good component of the article maybe this will also have some chronological graph of the treatments man has tried over time. All these pieces added within the scope should be faced and not suppressed through the passage of time and all will be encyclopaedically critiqued and balanced out which leads to a neat understanding of the many pieces that all the best articles have. The articles balancing will be that good everyone who reads it will have no choice but to think critically. Anything that adds richness and sticks to the subject it is discussing is the way.

Simply if something is added and is in the scope of the article, and then cited it should stay, and as it stays it is open to notes, additions and free thinking critique from anyone who reads it.

Anything other than that then it is definitely not a public resource encyclopaedia, it is a paradigm of spin for some section (e.g. once a minority of people were not allowed to analyse, free think and critique the paradigm that world was flat. If so in a hyper frenzy they were killed), marketing a perception, oppression, a dominant cult, it is not fair game and destroys the credibility of any article and brings a build up of resentment and non trust from other sections. It really does bring harm to the resource it makes it junk.

Rknight you see how I see an encyclopaedia.

As you can see this is all about compromise, respect, balance, critique and richness of detail.

Regarding your suggestions…

Lets get some background information first.

The myofibroblast is clearly implicated in scarring. There is independent cite after cite, after independent cite, stating the myofibroblast is implicated in scarring over every soft tissue in the body.

Therefore, anything that can attack, suppress, inhibit or kill the myofibroblast can be put forward as a treatment or a potential treatment with regards to scarring. That is common sense.

The mechanism of ACE inhibitors

ACE Inhibitors stop the conversion to angiotensin II from angiotensin I. Angiotensin II also induces myofibroblast proliferation (implicated in scar). Therefore there is a massive amount of logic that ACE Inhibitors will help with scarring. This is clear. Other studies have proved that ace inhibitors regenerage scar.

So as you can see before the citations are put in they have a massive background foundation. This is sturdy and is easily in the scope of the article.

ACE inhibitors have a place in the article and will always have a place in the article before you even put the cites in by the mere fact they inhibit the myofibroblast.

So now we have seen the back ground information. Lets go onto,

Primary & secondary sources

Lets look at this cite, this independent cite (number 1) by itself is a primary cite

"Low-Dose Enalapril in the Treatment of Surgical Cutaneous Hypertrophic Scar and Keloid - Two Case Reports and Literature Review". Pubmed. March 2009. Retrieved 2010-10-28. In the meantime, the patient was treated for mild arterial hypertension with low-dose enalapril (10 mg, once a day), coupled with a very low dose of hydrochlorothiazide (3 mg, once a day), administered in the morning. After 15 days of this treatment, the keloid scar dramatically improved, with a nearly complete recovery.

This independent cite( number 2) by itself is also a primary cite

"Treatment of a Postburn Keloid Scar with Topical Captopril: Report of the First Case Sir:" (PDF). Plastic and Reconstructive Surgery. March 2009. Retrieved 2010-10-28. with 5% captopril solution in cold cream. After 6 weeks of twice-daily application of the cream, a marked improvement of the keloid lesion was achieved as the height of the lesion decreased from 9 to 11 mm to 2 to 4 mm, the redness and scaling were noticeably eliminated, and she has not complained of itchiness (Fig. 1, below).

HOWEVER cite number 1 and cite number 2, also play the roles of secondary cites by the fact they are independent of another and they back each other up and they back the known knowledge of what happens to scar tissue when it is treated with ace inhibitors. Therefore these two cites are both secondary and primary citations.

In the article itself there is also another study about Liver fibrosis that is also a primary and secondary citation with regards to the use of ACE inhibitors. Again because it is independent it is a primary to itself, and a secondary to anything else that uses ACE inhibitors.

Along with that it is clearly a scientific consensus that ace inhibitors inhibit the myofibroblast which inhibits the scar healing.

• "Reliable primary sources may occasionally be used with care as an adjunct to the secondary literature, but there remains potential for misuse."
• "Primary sources should not be cited in support of a conclusion that is not clearly made by the authors or by reliable secondary sources,"

RKnight the two sources are ajunct to secondary literature AND scientific consensus with myofibroblast proliferation with regards to ACE inhibitors. The premise and the citation of these pieces are also accurate, therefor currently there is no misuse until they get twisted.

The primary sources do not conclude anything by themselves.

IMO these are quality references, they are cited and qualified they are useful to researchers and balanced they raise the integrity and value of the article.

My compromise is that:

The pieces should be put in the article and edited to give a fair transparent critique that we can all agree on.--Veryvery20 (talk) 12:15, 14 April 2011 (UTC)

---

I'm not going to compromise to break WP policy. The case reports fail WP:MEDASSESS, and the literature review found "After conducting this literature search, it became apparent that no data on cutaneous scars and ACE inhibitors are available."

You say: "Therefore, anything that can attack, suppress, inhibit or kill the myofibroblast can be put forward as a treatment or a potential treatment with regards to scarring. That is common sense." and "Angiotensin II also induces myofibroblast proliferation (implicated in scar). Therefore there is a massive amount of logic that ACE Inhibitors will help with scarring. This is clear."

I agree that the above statement is likely true; however, it's original research

Look, I'm not saying that never will ACE Inhibitors be listed on this article. I, myself, will personally add "A small study has found that ACE Inhibitors may be effective in improving the appearance of scarring in some patients.^{RCT Citation}" Or even, "In one study, researchers have shown ACE Inhibitor treatment to be superior to occlusion in improving the appearance of scarring.^{Big RCT Citation}" Eventually, "Recent trials have determined that ACE Inhibitor treatment may be effective and safe^{Secondary Source}, with similar effectiveness to laser therapy^{Big RCT Citation} and superior to other whatnots.^{Big RCT Citation} And won't it be a happy day when our little blurb can move into its own section? "ACE Inhibitor treatment is used to prevent and improve the appearance of certain types of scars^{Ultimate Citation}. This therapy works by ..."

Patience. If it works, there will be a clinical trial reflecting that soon enough. Rknight (talk) 01:27, 15 April 2011 (UTC)

We must present the conclusions of review articles and avoid the use of primary research per WP:MEDRS.Doc James (talk · contribs · email) 01:49, 15 April 2011 (UTC)

Editor assistance

Issues concerning this article have been raised at Wikipedia:Editor assistance/Requests#Dangerous advice on Scar. Please consider taking any advice offered by the EAR team. --Kudpung กุดผึ้ง (talk) 06:22, 11 April 2011 (UTC)

Needling

Removed because it lacks secondary sources, will clean up and add to research.

Needling, also called subcision, dermarolling, or percutaneous collagen induction therapy, began in 1997. It is a process where the scarred area is continuously needled to promote collagen formation. In 2008 a retrospective analysis of 480 persons concluded that it was effective; the patients applied vitamin A and vitamin C to the skin prior to and following the needling. A 2009 review of the therapy similarly concluded that it was effective.

The needles are typically standard medical grade stainless steel or newer variants made from titanium which can have minimal diameter yet retain strength and sharpness for reducing pain. The needles are fixed onto a plastic barrel which rotates around an axle that connects to a handle for holding the device. Once needled the area is allowed to fully heal, and needled again if required depending on the intensity of the scar. Scarring needles and needling rollers are available for home use; however, needling should not be done on parts of the face or areas where major nerves are located without professional medical supervision. Needling at home must also be done in line with hygienic and sterilization requirements. Despite the small length of home use needles, it is prudent to ensure that the microneedle roller has been gamma sterilised by the manufacturer as usually these devices are assembled by hand.

It is worth noting that severe scarring is unlikely to benefit from home based treatments as the user is unlikely to be able to penetrate deeply enough to create significant improvements. In the cases of deep scarring, only professional treatments are likely to work.

When are you planning on putting this backin? Standard practice on Wikipedia is not to remove well-referenced sections while they are improved on - it is rather to improve upon them while they are in article. Otherwise, the tendency is for people to remove things without good justification and never get around to the improvement. Aust 2009 is a review and could be considered a secondary source, particularly since it is not all the same authors, and in general WP:MEDRS means "reviews" when it says "secondary source". I don't think a review where the authors were not involved in a trial of the therapy is a necessary condition. Needling is a fairly recent discovery, but there are other research groups - e.g., Fabbrocini et al 2009. Recently another research group (Leheta et al 2011) did comparison to the "CROSS" technique (trichloroacetic acid) with comparable results. You could also look at Rennekampff et al 2010. If you don't have the time or resources to draw on these other sources and improve the section, then the section should be reinserted as is. II | (t - c) 11:38, 15 April 2011 (UTC)

I'm reading through the articles now; I think the section needs a major rewrite to bring it in line with the reviews. I took it out rather than put a citation needed tag after just about every sentence-- hence why I didn't consider it well-referenced. I expect to be finished reading tonight, and will start editing. My problems with the (single) secondary source/review, are that the primary author is a paid medical consultant for the needling people, the article deals with burn scars only, that needling is a type of subcision, and that the journal doesn't seem too prestigious. Further, I can't find needling or subcision mentioned in the J. of Burn Care Research. I've been going through conference proceedings and can't find needling anywhere, which tells me that it isn't even as popular as the other research treatments we have listed. Same for 'Percutaneous Collagen Induction Therapy'. Anyway, I'm not done, but I have doubts that it can be considered a valid treatment. Rknight (talk) 20:26, 15 April 2011 (UTC)

I'm not really following. Why are you looking through conference proceedings (typically less rigorously peer-reviewed and published) when I pointed to three published articles (after doing only a quick 5 minute search), in addition to the two already cited? Note that 2 dealt with acne scarring, not burns. What is the real relevance of J. of Burn Care Research? Needling doesn't seem to have been on the radar until recently, but popularity is not the main measure of a "valid treatment". Also, it's not our job to remove research based on unpublished gut skepticism, particularly when there's two reviews and three trials all in favor of a method, and the gut skepticism arises not from substantive observations but from some intuitive feelings. When you mention the single review/secondary source, are you talking about Aust 2009 or Rennekampff et al 201]? Also, conflicts of interest are nice to keep in mind but ubiquitous in medical research, and certainly not a good reason to invalidate articles alone. II | (t - c) 20:52, 15 April 2011 (UTC)

Mentions in conference proceedings aren't valid citations, but are a good idea of what clinicians are doing, and what researchers think is promising. The second review, Rennekampff (and Aust) is in 'Color Atlas of Burn Reconstructive Surgery' doesn't seem to have been peer-reviewed. Regardless, there's no secondary source I can find that even mentions it, research or otherwise; so now I have doubts that it's even that interesting of an experimental therapy. Still, it needs re-written to reflect its experimental nature. I'm not sure about subcision, though; it may be best to combine both subcision and needling. Rknight (talk) 04:49, 16 April 2011 (UTC)

It's been mentioned here that subcision and needling are effectively the same thing. I think I am ready to disagree based on this reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958495/?tool=pmcentrez This reference offers some of the best clarity of/to the differences between "needling" and "subcision". Sections 4.1.8 and 4.1.9 along with photos 6,7,8, do a good job of helping understand the differences and techniques. I've included a few more links below in the "subcision merger section" that might be of help as well.

I feel this information is relevant to this discussion therefore I inserted here as well. I hope the editors here find this is/was helpful to the improving of the article. Cheers.. Dijcks HotTub Pool 20:41, 19 April 2011 (UTC)

Subcision Merger

Subcision is currently a stub, and probably belongs under the treatments section here. It doesn't have any valid references, though, so I'm going to move it into talk now to be improved. Hands for merger? Rknight (talk) 06:13, 19 April 2011 (UTC)

It will likely never be more than a stub because its definition doesn't require copious amounts of text, unless someone is willing to get into the various uses, techniques vs. needling (for example), history, studies.

If I understand it correctly, there is a difference between subcision and needling.

• Needling employs the use of a tattoo gun-like device to make numerous punctures into the skin, thus breaking up the scar tissue underneath.
• Subcision, employs the insertion of a needle under the skin "fanning" in way that breaks-up or effectively slices the scar tissue (hence, sub"cision").

That said, subcision by definition is not a type of scar so it could be argued that it should remain a stub, and see where it goes. Dijcks HotTub Pool 08:27, 17 April 2011 (UTC)

scar has a section on treatments and I think it would be appropriate to merge it there.--Taylornate (talk) 06:53, 30 May 2011 (UTC)

I think needling, technically, is a type of subcision. It's primary use appears to be as a surgical treatment for scarring. Regardless, some secondary sources: Current therapeutic approach to acne scars, Treatment of facial scarring: lasers, filler, and nonoperative techniques, An evidence-based assessment of treatments for cellulite, Esthetic and cosmetic dermatology. Some free full text aricles: Acne scar subcision, Subcision in rolling acne scars with 24G needle. Rknight (talk) 06:13, 19 April 2011 (UTC)

It might be a type of subcision but check out this reference link and then notice Section 4.1.8. about Needling (check out the photos fig 6,7,8 too). Then check out Section 4.1.9. Combined Therapy regarding subcision http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958495/?tool=pmcentrez . I believe this does make a good argument for the difference. I personally wouldn't make analogous use of the two terms, but it's to you guys over here.

Here are a few more links regarding subcision that you might find interesting should you decide to add this practice to the article.

http://onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2005.31080/full

http://onlinelibrary.wiley.com/doi/10.1111/j.1468-3083.2010.03711.x/abstract

http://onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.2004.30411.x/full

Dijcks HotTub Pool 19:42, 19 April 2011 (UTC)

Treatment: Subcision

Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. It is also used to lessen the appearance of severe glabella lines, though its effectiveness in this application is debatable. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue.

External links

• Subcision
• Subcision for Acne Scars

Dermal Fillers

Dermaflage is the first topical dermal filler on the market. This innovative product bridges the gap between plastic surgery and make-up.

Safe, in every way. Dermaflage is made of medical grade products with FDA approved ingredients. The patent pending process was developed in Hollywood for the stars and is now available to everyone.

Make up just cakes and opaques. Dermaflage is waterproof, cannot be smeared or smudged--and it lasts for up to 36 hours. Unlike make-up, it is not opaque and does not give the wearer an unattractive, caked look. Dermaflage moves with you. Silicone moves with the face muscles so there is never any cracking or peeling. For millions of people that suffer from facial and acne scars that cannot be removed with plastic surgery, this is the right solution.

Color matching. Dermaflage comes in both an Ethnic and Caucasian starter kit. Each starter kit has three basic skin tones that will match nearly every skin color. Once you know your match, order a re-fill kit with your matching tone. — Preceding unsigned comment added by Dermaflage (talk • contribs) 14:24, 11 August 2011 (UTC)