2017-18 HSC Section 4 Green Book

V E RH I E L E T A L

Figure 1. Study attrition diagram. Three major databases were queried for appropriate studies, and exclusion and inclusion criteria were applied. Fourteen publications were classified into two categories.

production. 28,31 Doong and colleagues and Boggio and colleagues found that calcium antagonists alter cell shape from bipolar to spherical and depolymerize actin fi laments by decreasing the cytosolic calcium concen- tration. This in turn turns on procollagenase gene expression. 29,33 Furthermore, it has been observed that keloid fi broblasts show elevated interleukin (IL)-6 expression, 30 and that calcium antagonists seem to inhibit the production of this IL-6 and of vascular endothelial growth factor (VEGF). 31 Most studies describe the induction of collagenase and, evenmore, of procollagenase synthesis as an important component of mechanism of action. 29,31 – 33 Finally, it was reported that calciumantagonists augment decorin expression in animal models, when added to intralesional tri- amcinolone. 32 Table 1 includes a summary of the results that were described.

were included in the second category ranged from case reports to randomized controlled trials. 24,34 – 40 The size of the study population from the selected studies ranged from 5 to 120 subjects, with a fair distribution of male and female participants. All eight articles reported data on ef fi cacy; only fi ve articles reported data on adverse events. Not all articles described the tool that was used to assess ef fi cacy; one article used photography to record scar volume and color, 24 one article used their own classi fi cation according to appearance as very poor to excellent, 36 two articles used the validated Vancouver Scar Scale (VSS), 38,39 and one article used the Stony Brook Scar Evaluation Scale. 40 Three articles did not speci fi cally report the assessment tool that they used. 34,35,37 All articles that were included in the fi rst category described in vitro studies. Dermal fi broblasts, mostly human, were cultured in a cell medium. Several differ- ent components that add to the mechanism of action of calcium antagonists were described. Two studies showed that calcium antagonists retard the incorpora- tion of proline into the extracellular matrix, delaying its Mechanism of Action

Efficacy and Adverse Events

The median methodological quality rating of the eight studies on ef fi cacy and adverse events was 3.5, with a range from two to four (Table 2). Two articles that reported a total of 13 cases showed that calcium antagonists were effective in 10 patients, with partial to

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