Therapy of pathological scars

A scar develops following the appearance of a deep tissue defect as part of the physiological wound healing process. The initial inflammatory response is followed by proliferation of connective tissue cells, which form fibrosis as a final tissue substitute. Disorders can occur at all stages of the process and are most commonly manifested as impaired wound healing or the formation of atrophic and hypertrophic scars or keloids. The focus of this article is on the treatment of pathologic scars, which are an indication for therapy due to functional limitations, complaints, and stigmatization, among other reasons. Conservative medical, physical, surgical and laser therapeutic approaches are pursued. The basis for this is an understanding of the pathophysiological mechanisms and factors influencing the choice of therapy, as well as an interdisciplinary and interprofessional therapeutic approach.     

Early-Life and Family Risk Factors for Tic Disorder Persistence into Adulthood

Background

Many children with tic disorders outgrow their tics, but little is known about the proportion of individuals who will continue to require specialist services in adulthood and which variables are associated with tic persistence.

Objectives

The aims were to estimate the proportion of individuals first diagnosed with tic disorders in childhood who continued to receive tic disorder diagnoses after age 18 years and to identify risk factors for persistence.

Methods

In this Swedish nationwide cohort study including 3761 individuals diagnosed with tic disorders in childhood, we calculated the proportion of individuals whose diagnoses persisted into adulthood. Minimally adjusted logistic regression models examined the associations between sociodemographic, clinical, and family variables and tic disorder persistence. A multivariable model was then fitted, including only variables that were statistically significant in the minimally adjusted models.

Results

Seven hundred and fifty-four (20%) children with tic disorders received a diagnosis of a chronic tic disorder in adulthood. Psychiatric comorbidity in childhood (particularly attention-deficit hyperactivity disorder, obsessive-compulsive disorder, pervasive developmental disorders, and anxiety disorders) and psychiatric disorders in first-degree relatives (particularly tic and anxiety disorders) were the strongest risk factors for persistence. We did not observe statistically significant associations with socioeconomic variables, perinatal complications, comorbid autoimmune diseases, or family history of autoimmune diseases. All statistically significant variables combined explained approximately 10% of the variance in tic disorder persistence (P < 0.0001).

Conclusions

Childhood psychiatric comorbidities and family history of psychiatric disorders were the strongest risk factors associated with tic disorder persistence into adulthood. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.