Atrophic scars as an object of inorganic gel treatment

Atrophic scars are a complex problem, covering a huge number of patients with striae gravidarum, acne, atrophic surgical scars, and striae due to hypercortisolism and other metabolic disorders. Taking into account patients' social status (pregnant women, adolescents, people with chronic hormonal disorders), our goal was to systematize the literature data on the least invasive treatment modality - atrophic scar therapy with inorganic gels - to identify new chemical classes with potential anti-scar activity. When summarizing research data over the past 10 years, it was found that the effect of anti-scar therapy depends on the atrophic scar color - hyper- or hypopigmented, its type - wedge-shaped, scaphoid, or rectangular, its origin - post-acne, cicatricial alopecia, infectious scars, stretch marks, or post-traumatic atrophic. The stage of pathogenesis also plays a significant role: aseptic inflammation, infiltration of hematogenous differential cells, mast cell degranulation, release of bioactive substances and changes in the VEGF, TGF-ft1, EGF, FGF, PDGF growth factors, migration of activated macrophages, damage to elastic and collagen fibers, perivascular lymphocytic infiltration, impaired hemorheology, chronic inflammatory process, increased number of senescent fibroblasts, decreased synthetic activity of atrophic scar cells, decreased cellularity and vascularization of the atrophic scar area. In case of high bioinertness of inorganic gels, the anti-scar effect is achieved due to the exfoliating effect, epidermal-mesenchymal interactions, and the impact of the mesoporous gel structure on scar hydration. In addition to the well-known silicone gel, sol-gels based on aluminum dioxide have similar properties, which makes it possible to consider sol-gel as an alternative to silicone gel.