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

Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children
Issue online:
19 Jul 2004
Manuscript received: November 21, 2003
Accepted in final form: March 1, 2004
To cite this article: Gisele V. de Oliveira MD, Arthur P. Sanford MD, Kevin D. Murphy MD, Hermes M. de Oliveira MD, Judy P. Wilkins RGN, Xiaowu Wu MD, Hal K. Hawkins MD PhD, Gregory Kitten PhD, David L. Chinkes PhD, Robert E. Barrow PhD, David N. Herndon MD (2004)
Growth hormone effects on hypertrophic scar formation: a randomized controlled trial of 62 burned children
Wound Repair and Regeneration 12 (4), 404Ò411.
doi:10.1111/j.1067-1927.2004.012407.x
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Gisele V. de Oliveira, MDa,c,dShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of SurgeryaPathologyb, and Dermatologyd; Arthur P. Sanford, MDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Kevin D. Murphy, MDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Hermes M. de Oliveira, MDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Judy P. Wilkins, RGNaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Xiaowu Wu, MDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Hal K. Hawkins, MD, PhDa,bShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of SurgeryaPathologyb, and Dermatology; Gregory Kitten, PhDdd; David L. Chinkes, PhDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; Robert E. Barrow, PhDaShriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya; David N. Herndon, MDa*Shriners Hospital for Children and The University of Texas Medical Branch, Galveston, TX, Departments of Surgerya*David N Herndon, MD, Shriners Hospitals for Children, 815 Market Street, Galveston, TX 77550. Fax: (409) 770-6919; Email: dherndon@utmb.edu.

*David N Herndon, MD, Shriners Hospitals for Children, 815 Market Street, Galveston, TX 77550. Fax: (409) 770-6919; Email: dherndon@utmb.edu.

Abstract
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 18Ò24 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 18Ò24 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.

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