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Experts present updated guidelines in scar management

An international group of 24 experts from a wide variety of specialties published guidelines on managing, preventing and treating scars after invasive and non-invasive procedures in the Journal of Plastic, Reconstructive & Aesthetic Surgery.

For the prevention of scarring immediately after wound closure, the three major components are tension reduction, hydration/taping/occlusion and pressure garments, according to the researchers.

Moisture emollient, humectant creams and moisture-retentive dressings such as silicone sheets and fluid silicone gel benefits scar itching, and can reduce the size and pain associated with some scars, as well as improve their appearance.

For widespread scars, pressure garments are recommended for wounds that take longer than 2 to 3 weeks to heal. The garment may be applied as soon as the wound is closed and the patient can tolerate the pressure, according to the researchers.

Altering the levels of cytokines is currently under investigation for scar prevention. The researchers reported that data from initial clinical studies involving the alteration of transformation growth factor-b3 have shown this treatment may reduce scar formation after full-thickness incisions are performed.

In linear hypertrophic scars, silicone therapy is suggested. For ongoing hypertrophy, intralesional corticosteroids may be necessary, according to the expert panel.

“Despite the fact that there are very few studies on the technique of corticosteroid injections in children, most experts agree that this technique is not contraindicated in these young patients, but that dose adaptation to the child’s weight is advised to avoid systemic exposure,” the researchers wrote.

Bleomycin, 5-fluorourcil and verapamil, may also help to treat hypertrophic scars and keloids, as well.

For widespread hypertrophic scarring, early application of silicone and compression therapy is essential for patients as risk following burns, mechanical trauma or necrotizing infections.

According to the researchers, recent study findings have underlined the critical role of cellular mechanoreceptors in the high success rate of compression therapy.

Laser therapy is another option that can be used to treat abdominal scars and may treat residual redness, telangiectasias or hyperpigmentation.

For keloid treatment, silicones in combination with pressure therapy and intralesional injections of corticosteroids should be considered first. Intralesional 5-fluorourocil, bleomycin and verapamil may also be considered, in accordance with existing treatment protocols, the researchers wrote.

If the keloid does not improve in 12 months of these treatments, surgical excision should be considered. However, it must be considered in combination with some form of adjuvant therapy, as excision alone has been associated with a high recurrent rate of 50% to 100% and can result in enlargement, according to the researchers.

“Treatment of hypertrophic scars, contractures and keloids is generally based on the reducing mechanical tension in the scar, removal of the bulky scar tissue by reconstructive surgical techniques and/or injection of substances that promote collagen breakdown in situ,” the researchers concluded.

Silicone sheets are gels are also recommended as the gold standard non-invasive therapy for prevention and treatment of scars and keloids. – by Abigail Sutton

Disclosure: Monstrey has no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.