Celsus' writing in the first century AD recommended the application of a lotion made of wine and myrrh. In the mid-16th century, Ambroise Paré (a famous battlefield surgeon) treated burns with onions and was one of the first to describe the need for early excision of burns [4]. In the 19th century, Jaques Reverdin introduced the concept of skin grafting to cover burns affecting large areas of the body, improving the diagnostic and surgical understanding of burns [10].
Nevertheless, the 21st century has simultaneously seen a remarkable change in the global distribution of burn injuries. In the models covered in this review, burn wound sizes range from 5% to 50% of the total body surface area (TBSA), and the wounds have varying depths. Mice in the model are shaved and ethanol is applied to the shaved back.
Smoke inhalation injury has a procoagulant activity leading to fibrin deposition in the airways, therefore aerosolized administration of anticoagulants may have beneficial effects [87]. However, the intermediate area called the penumbra in the case of ischemic stroke or the stasis zone in the case of burns can develop either way and is therefore critical. Improved tissue survival correlated with increased Na-KATPase, decreased malondialdehyde/oxidative damage, and reduced inflammation in the stasis zone.
Burn contraction, bark thickness and edema formation were significantly reduced in the treatment group compared to controls after 8 days.
Anti-oxidants
Although corticosteroids are the classic anti-inflammatory agents, their use is controversial in burn healing [103]. Singer et al. [103] showed that topical application of a potent topical steroid cream (clobetasol propionate) in pigs with second-degree burns did not prevent the progression of secondary burns.
Anti-apoptotic and pro-survival agents
Physical agents
Burn dressings
Infection
Light is attractive as an antimicrobial approach to treating burn infections that tend to be superficial and unresponsive to antibiotics due to resistance of poorly perfused tissue.
Regeneration
Prevention and treatment of scars
Antimicrobial photodynamic therapy uses the combination of topically applied photosensitizing dyes excited by visible light to generate ROS and kill microbial cells [ 150 ]. Mannose-6-phosphate (M6P) inhibits the activation of TGF-β1 and TGF-β2 [182] and local application of recombinant M6P has been studied to treat scars (clinicalTrials.gov: . NCT00984516 and NCT00984854), under the company, under the company. brand name Juvidex. Keloid fibroblasts are characterized by increased expression of FAP-α, and normal adult tissues are generally FAP-α negative.
Furthermore, it was reported that RNAi-mediated downregulation of Smad3 expression reduced collagen production in keloid fibroblasts [ 187 ]. A range of different inhibitors could be candidates for this target, including TRAP-1-like protein (TLP), which co-activates Smad2, halofuginone, quercetin, P144, trichostatin A (TSA), and paclitaxel, among others [188]. Halofuginone is a selective inhibitor of collagen type 1 synthesis and blocks TGF-ß-mediated activation of Smad3 in fibroblasts, thereby inhibiting dermal fibrosis in vivo [189].
The peptide P144 is derived from the human TGFβ type III receptor (betaglycan) and inhibits both Smad3 and Smad2 as well as TGFβ1. P144 was shown to reverse bleomycin-induced skin fibrosis when applied topically to mice [193] and reduced periprosthetic capsular contracture in pigs [194] . Asiaticoside is a phytochemical extracted from the leaves of the Indian centella asiatica that activates Smad7 in normal and hypertrophic scar fibroblasts, reducing.
Another herbal medicine that upregulates Smad7 and blocks Smad2/3 is 'Boui' or tetandrine which is a bis-benzylisoquinoline alkaloid [196]. A uthor Man uscr ipt A uthor Man uscr ipt A uthor Man uscr ipt A uthor Man uscr ipt.
Conclusion
Expert opinion
Burn patients with diabetes have a worse prognosis in terms of infection, wound healing and overall survival [203]. Therefore, pharmaceutical interventions designed to correct the metabolic disturbances that occur in burn patients will have applications that may extend beyond burns. In a similar vein, the pathophysiological aspects of smoke inhalation injury share aspects with acute respiratory distress syndrome (ARDS) found in patients with pneumonia and sepsis.
One example is the controversy surrounding the use of low dose corticosteroids in sepsis and critically ill patients [204, 205]. Agents designed to prevent the progression of burns have shown success in many animal models, but there have not yet been many controlled clinical trials. Perhaps this is because the adoption of early excision and skin grafting makes it less critical to follow and intervene in the zone of stasis to prevent tissue necrosis from increasing.
However, the investigation of new agents designed to arrest the progression of tissue necrosis has applications far beyond the issue of burn conversion. An example is the use of antioxidants, which have had mixed results in many clinical trials. The modern view is that oxidative stress can be both good and bad at the same time.
Many signaling pathways are activated by reactive oxygen pathways, and blocking all oxidative stress may indeed be counterproductive. While excessive inflammation is clearly bad under many circumstances, blocking all inflammation can also be counterproductive. The use of mesenchymal stem cells for the prevention and repair of multiple types of tissue damage is intensively researched, and burns are no exception [206].
There is still debate as to how much of the benefit of stem cell therapy is due to the long-term engraftment of the stem cells at the actual site of injury and how much is due to the anti-inflammatory effects that the stem cells exert on the host. answer [207]. Prevention of scarring is also being intensively researched, as burn scars can be life-changing consequences. The discovery of the TGFβ pathway has led to studies examining pharmaceutical interventions to modulate the various biochemical steps that lead to the formation of hypertrophic scars and keloids.
Acknowledgments
