Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018

Abstract

There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

Hypertrofic scar – associated ultrasound aspects after thyroidectomy

“…We introduce two cases of total thyroidectomy that actually were evaluated one month after surgery and the post-operatory scars seem hyper-trophic. The evaluation is still too early to fully predict the partial remission or the transformation to keloids (6). Close follow-up is necessary in order to adequate management.…”

“…(7). The risk factors have been introduced in specific scores by some working groups (6). The guidelines of diagnosis and treatment vary (6,8).…”

“…The risk factors have been introduced in specific scores by some working groups (6). The guidelines of diagnosis and treatment vary (6,8). Topical solutions seem the most reasonable approach as therapy (8).…”

Toe Keloids Treated with Core Excision, Postoperative Radiotherapy, and Steroid Plaster

“…Such postoperative irradiation is well known to suppress new angiogenesis and inflammation, both of which play key roles in keloid (re)growth. 12 , 13 With regard to the second toe (which had proved to be the most troublesome of all the three toe keloids), we speculated that the planned postoperative irradiation could hamper the peripheral circulation. Therefore, we did not subject the second toe to irradiation.…”

“…The first-line treatment for pediatric toe keloids is therefore application of steroid tape, which should be continued until keloid resolution or adulthood, as needed. 13 …”