Hypertrophic scar formation is associated with an increased number of epidermal Langerhans cells

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Abstract
The exact pathogenesis of hypertrophic scar and keloid formation is still unknown and a good therapy to prevent or treat these scars is lacking. Because immunological processes seem to be important in excessive scar formation, immunological cells and parameters were studied in a standardized breast reduction wound‐healing model in the present study. Standardized scar samples were taken from infra‐mammary breast reduction scars, 3 and 12 months following surgery. The samples were investigated for their number of mast cells, Langerhans cells, T‐lymphocytes, and macrophages, and the presence of interleukin‐4 (IL‐4) and counter‐regulating interferon‐gamma (γ‐IFN), in relation to the scar's clinical appearance—normal or hypertrophic. In this study, hypertrophic scar formation was significantly associated with an increased number of epidermal Langerhans cells (p = 0.0001) and significantly (p < 0.05) increased expression of epidermal IL‐4. No relationship was found between mast cell, T‐lymphocyte and macrophage numbers or γ‐IFN staining and the formation of normal or hypertrophic scars. These results, combined with previous observation of abnormal keratinocyte behaviour in this context, indicate that the epidermal immune barrier plays an important role in the development of hypertrophic scars. Copyright © 2003 John Wiley & Sons, Ltd.