Updated Recommendations for Hypertrophic Scar and Keloid Management

Abstract

T here are many lines of treatment of hypertrophic scars and keloids that discussed in details like topical silicone, pressure therapy, intralesional injections of corticosteroid, interferon and fluorouracil, and pulsed-dye laser treatment. No single therapy has been universally adopted as the standard of care for clinical practice. The most important management is prevention by proper surgical planning, immediate post operative care, pressure garment use, silicone and steroid injection. Treatment is divided either surgical or non surgical. Surgical therapy should be combined with adjuvant treatment such as pressure, corticosteroids, and radiotherapy Non surgical treatment includes pressure garment either ready to wear or custom made, Silicone gel has evidence of efficacy but non compliance may occur due to repeated multiple application and early removal due to friction with clothes so silicone patch can be used , LASER treatment includes flashlamp pulsed dye and near infrared , LASER can be selected according to certain criteria like skin phototype and absence of inflammation, expectation and compliance of the patient, corticosteroids can be used every few weeks but tissue atrophy, hypopigmentation and telangiectasia may develop, combination of 5-Fluorouracil with corticosteroids has fewer undesirable side effects than intralesional corticosteroid injection alone. Immune modulators and antibody therapies are new in the context of problem scars, further molecular investigations will yield more specific, probably gene-based, therapies that are designed not only to treat, but also to prevent problem hypertrophic and keloid scars.