The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago

Abstract

Background: In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review. Methods: All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available. Results: Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis. Conclusions: Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.

Hemodynamics and Vascular Histology of Keloid Tissues and Anatomy of Nearby Blood Vessels

“…These findings suggest that improving the congestion in keloids could be a viable therapeutic strategy for these lesions. This may be a significant finding because although recent studies have greatly improved our understanding of keloidogenesis, 17–20 the mechanisms that underlie keloid progression and could be targeted therapeutically remain to be elucidated.…”

“…there was Kc in the vicinity. because although recent studies have greatly improved our understanding of keloidogenesis, [17][18][19][20] the mechanisms that underlie keloid progression and could be targeted therapeutically remain to be elucidated.…”

Pigmentation and Scaring Management after Hypodermoclysis, a Case Report

“…For example, a millisecond Alexandrite 755 nm laser can be used for laser hair removal. However, it is primarily used for tattoo and pigmentation removal in the picosecond range (4)(5)(6)(7)(8). Most lasers use a similar mechanism of action based on photothermolysis [20].…”

“…It is well known that cutaneous injury from various causes can result in abnormal pigmentation, either hypo or hyperpigmentation, and resistant scarring. Lasers are commonly used to treat skin pigmentation and scarring [7][8][9]. The laser technologies available for the treatment of skin lesions have undergone a revolution in the last decade [10].…”

Use of Adipose Stem Cells Against Hypertrophic Scarring or Keloid

“…Therapeutic strategies for treating hypertrophic scars include steroid injection, surgical hypertrophic scar removal, radiotherapy, compression, and cryotherapy, pulsed dye and CO 2 laser, silicone gel, nanoparticles and radiotherapy, among others ( Salameh et al, 2021 ; Ogawa, 2021 ; Svolacchia et al, 2016 ; Nicoletti et al, 2013 ; Riccio et al, 2019a ; Jimi et al, 2020 ; Barrera, 2003 ; Aoki et al, 2020 ). However, existing treatments are not guaranteed to reduce recurrence of keloids, due to the high recurrence rate thereof at the hypertrophic scar excision site ( Coentro et al, 2019 ; Kumar and Kamalasanan, 2021 ).…”