Evidence-Based Scar Management: How to Improve Results with Technique and Technology

Khansa, Ibrahim; Harrison, Bridget; Janis, Jeffrey E.

doi:10.1097/prs.0000000000002647

Cited by 121 publications

(45 citation statements)

References 117 publications

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“…However, HSs are often more responsive and less prone to recurrence, which makes them therapeutically less challenging. To date, multiple invasive and non-invasive therapies have been used and proposed, but none of these has been adequately evaluated in high-quality studies (60). Management of HS has transitioned from invasive methods to intralesional and topical therapies that act at a cellular level (61).…”

Section: Hss Versus Keloidsmentioning

confidence: 99%

Current Therapeutic Approach to Hypertrophic Scars

et al. 2017

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Abnormal scarring and its accompanying esthetic, functional, and psychological sequelae still pose significant challe nges. To date, there is no satisfactory prevention or treatment option for hypertrophic scars (HSs), which is mostly due to not completely comprehending the mechanisms underlying their formation. That is why the apprehension of regular and controlled physiological processes of scar formation is of utmost importance when facing hypertrophic scarring, its pathophysiology, prevention, and therapeutic approach. When treating HSs and choosing the best treatment and prevention modality, physicians can choose from a plethora of therapeutic options and many commercially available products, among which currently there is no efficient option that can successfully overcome impaired skin healing. This article reviews current therapeutic approach and emerging therapeutic strategies for the management of HSs, which should be individualized, based on an evaluation of the scar itself, patients’ expectations, and practical, evidence-based guidelines. Clinicians are encouraged to combine various prevention and treatment modalities where combination therapy that includes steroid injections, 5-fluorouracil, and pulsed-dye laser seems to be the most effective. On the other hand, the current therapeutic options are usually empirical and their results are unreliable and unpredictable. Therefore, there is an unmet need for an effective, targeted therapy and prevention, which would be based on an action or a modulation of a particular factor with clarified mechanism of action that has a beneficial effect on wound healing. As the extracellular matrix has a crucial role in cellular and extracellular events that lead to pathological scarring, targeting its components mostly by regulating bone morphogenetic proteins may throw up new therapeutic approach for reduction or prevention of HSs with functionally and cosmetically acceptable outcome.

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Section: Hss Versus Keloidsmentioning

confidence: 99%

Current Therapeutic Approach to Hypertrophic Scars

et al. 2017

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“…Selection between different treatment modalities is usually experience based and the varying success rates were obtained. Khansa et al performed a literature review to provide evidence-based evaluation on the effectiveness of different treatment methods for keloid (26). Treatment modalities including silicone gel, PDL, TAC, and 5-FU showed high efficacy in improving keloid.…”

Section: Discussionmentioning

confidence: 99%

“…Treatment modalities including silicone gel, PDL, TAC, and 5-FU showed high efficacy in improving keloid. In contrast, onion extract and fat grafting exhibited low efficiency (26). In this study, we further compared the effectiveness of TAC with different treatment regimes.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Triamcinolone Acetonide in Keloid Treatment: A Systematic Review and Meta-analysis

Wong

Chen

et al. 2016

Front. Med.

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Keloid is a cutaneous dermal outgrowth resulting from uncontrolled deposition of collagen and glycosaminoglycan around the wound. The uncontrolled and persistent growth of keloids scar will result in cosmetic disfigurement, functional impairment, and affect the quality of life. Triamcinolone acetonide (TAC) is traditionally employed in treating keloid scars. In this study, we aim to evaluate the effectiveness of TAC and compare it with other common therapy employed in keloid treatment. Only randomized controlled trial (RCT) and controlled trial were included. Inverse variance risk ratio, weighted mean difference, and corresponding 95% confidence intervals were calculated to evaluate the effect of intervention. Meta-analysis indicated that TAC treatment significantly reduced the size of keloid compared to untreated control. Reduction in size was statistically different in favor of TAC compared to silicone gel sheet. Significant difference in favor of TAC was observed compared with verapamil in term of vascularity and scar pliability. TAC treatment was more effective in reducing scar thickness in comparison with cryotherapy. However, the current meta-analysis has several limitations. Only a limited number of trials with the same comparison are available. Most trials recruited a small number of patients and used inconsistent outcome assessment. Most trials did not provide detail information on allocation concealment and blinding. Therefore, further evaluation in multi-center RCTs with consistent comparisons and outcome measurements are warrant to reach a consensus on the selection between TAC and different treatment modalities.

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“…Resultant surgical scars, especially after mastectomy, are often so profound and distinct that they hinder the man’s ability to “pass” as their identified gender when topless. Treatment options include laser and light sources, radiofrequency devices, and injectables such as corticosteroid medications, depending on whether the scars are atrophic, hypertrophic/keloidal, or erythematous (Khansa et al, 2016). …”

Section: Gender Confirmation Surgerymentioning

confidence: 99%

Dermatologic care of the transgender patient

Ginsberg

2017

International Journal of Women's Dermatology

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Given the complexities of the transitioning process, transgender individuals may face unique dermatologic needs in addition to routine care. Exogenous hormones affect hair and sebum production, gender-confirming surgeries often require dermatologic pre- and postoperative interventions, and postoperative anatomy may show unique presentations of routine skin conditions. Aesthetic techniques that are often used for rejuvenation may have a role in facial feminization and masculinization and unfortunately are too frequently performed by nonmedical personnel with negative consequences. Ultimately, physicians should strive to make their office a more accommodating environment for transgender individuals.

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Evidence-Based Scar Management: How to Improve Results with Technique and Technology

Abstract: Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.

Cited by 121 publications

References 117 publications

Current Therapeutic Approach to Hypertrophic Scars

Current Therapeutic Approach to Hypertrophic Scars

The Efficacy of Triamcinolone Acetonide in Keloid Treatment: A Systematic Review and Meta-analysis

Dermatologic care of the transgender patient

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