LAUSR

INTRODUCTION Raised dermal scars including hypertrophic, keloid and scalp-associated fibrosing Folliculitis Keloidalis Nuchae (FKN) are fibrotic disorders that mostly occur following cutaneous injury. They are characterized by increased extracellular matrix (ECM) deposition, primarily excessive collagen type 1 production by hyperproliferative fibroblasts. The intensity of ECM deposition is proportional to the severity of fibrosis as such; with hypertrophic scars being less fibrotic, compared with keloids and FKN. Due to a lack of suitable study models, therapy for raised dermal scars remains ill-defined. AIM Studies have not fully elucidated the immunological cues in cutaneous fibrosis, hence the desired effect of several immune related therapies including regulation of anti-inflammatory cytokines are yet to be elucidated. In this review, we will discuss the importance of immune factors in the pathogenesis of raised dermal scarring. METHODS We provide an up-to-date comprehensive review of the literature, from PubMed, Scopus, and other search engines to describe the immunological factors associated with raised dermal scarring. RESULTS Importance of immune cells including mast cells, macrophages, lymphocytes, and relevant molecules such as cytokines, chemokines, and growth factors, antibodies, transcription factors and other immune-associated molecules as well as immune factors and tissue lymphoid aggregates with raised dermal scarring will be presented. Growing body of evidence points to a shift from proinflammatory Th1 response to regulatory/anti-inflammatory Th2 response is linked to fibrogenesis in raised dermal scarring. CONCLUSIONS A better understanding of immune and associated molecular markers will enable better understanding of their potential as possible therapeutic, diagnostic and theragnostic targets in fibrotic raised dermal scarring.