Fibrosis: the unpleasant truth about human tissue repair and why we need better foresight in 2020

So, what did really happen in terms of evolutionary planning for mammals, when it came to tissue regeneration and in particular dermal repair (skin healing)?

Did man seriously miss out to amphibians on the regenerative card?   Yes, sadly it’s true. Somehow, it was decided that a quick skin ‘repair’ would suffice for mankind without the benefit of scarless healing seen in early foetal regeneration as we reach adult form.

https://www.ncbi.nlm.nih.gov/pubmed/24863070

Or is it, that the selfish gene has declared its hand by saying perfection in the adult form is not a prerequisite or indeed necessary for survival.   After all an unsightly cutaneous repair no matter how dysfunctional is sufficient for our survival.

The reality is, unless you are in the first or second trimesters of gestation, there is no hope for mammalian dermal regeneration!   After the third trimester, no mammal is immune to non-regenerative repair post injury. Therefore, a deep enough dermal injury in the adult human skin will leave one with a permanent mark. 

At best, the resulting scar would become a relatively inconspicuous fine line, a permanent visible scar, nonetheless.  

At worst, one may have to contend with a depressed atrophic or raised (sometimes contracted) hypertrophic or keloid scar.

A keloid is a permanent, often progressively expansive symptomatic dermal lesion albeit benign (from a neoplastic perspective) which behaves rather aggressively as it invades healthy surrounding skin especially in genetically susceptible individuals.

Moreover, the problem with dermal fibrosis aside from it’s increasingly socially unacceptable cosmetic appearance are more importantly, issues surrounding ongoing symptoms of pain, tenderness and pruritus and the significant functional morbidity affecting movement particularly those across joints in some individuals.

In view of its permanent morbid nature, certainly, the psychological https://www.ncbi.nlm.nih.gov/pubmed/18617450, social and healthcare cost issues may haunt individuals afflicted by dermal fibrosis of any kind. 

Notwithstanding the above issues of clinical significance, it is imperative to understand fibrosis not just for accurate objective assessment https://www.ncbi.nlm.nih.gov/pubmed/30729516 but also for enhanced management of cutaneous fibrosis which to date remains ill-defined and clinically challenging https://www.ncbi.nlm.nih.gov/pubmed/24098903;https://www.ncbi.nlm.nih.gov/pubmed/24680006. Moreover, understanding dermal fibrosis is a scientific area of critical importance of relevance not only to human skin but of relevance to other organs affected by fibrosis (e.g. hepatic, renal, pulmonary, cardiac and peritoneal fibrosis).

So, here’s my wish for a visionary collaborative research in 2020:

Let’s focus and prioritise research efforts and associated funding into this area long overdue our collective  attention.  In particular, let’s increase collaborative opportunities with colleagues and industry in order to make a truly tangible impact.  In 2020, by shining a spotlight on our understanding of cutaneous fibrosis, working together; we are bound to make greater progress to give this area of clinical and scientific research the significance needed for all mankind to benefit from. Are you with me?