Table 2 Hypertrophic scars and keloids: current therapeutic strategies.
From: Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies
Treatment | Use | Indications, efficiency and comments |
|---|---|---|
Prophylaxis | ||
Pressure therapy | Continuous pressure (15–40 mmHg) for at least 23 h/d ≥6 months of scar healing | • Prophylaxis of hypertrophic burn scars, ear keloids (postexcision) • Controversial success • Reduced compliance due to frequent patient discomfort |
Silicone gel sheeting | ≥12 h/d for ≥2 months beginning 2 weeks after wound healing | • Prophylaxis for the development of hypertrophic scars and keloids • No effects on mature keloids and hypertrophic scars |
Silicone gel | Twice daily for 2 months beginning 2 weeks after wound closure | Â |
Flavonoids | For example, Contractubex gel (Merz Pharma, Frankfurt, Germany), Mederma Skin Care Gel (Merz, Pharmaceuticals, Greensboro, NC, USA). Twice daily for 4 to 6 months beginning 2 weeks after wound closure | • Limited to prophylaxis of hypertrophic scar and keloid development |
Current therapies | ||
Corticosteroids | Intralesional injections of TAC (10–40 mg/mL), several treatments once or twice a month | • First-line therapy for keloids, second-line therapy for hypertrophic scars • Combination with surgery, PDL and cryotherapy • Common adverse effects: skin and subcutaneous fat atrophy, telangiectasias |
Cryotherapy | Contact/spray freezing with liquid nitrogen using 10–20 s freeze-thaw cycles | • Overall effective for hypertrophic scars, for keloids combination with triamcinolone acetonide injections recommended • Limited to management of smaller scars • Common adverse effects: blistering and pain |
Scar revision | Excision with linear, tension-free closure, split- or full-thickness skin grafting, z-plasty, w-plasty | • Efficacious for therapy of hypertrophic scarring • Recurrence rates of 45–100% after keloid excision without adjuvant therapy |
Radiotherapy | Superficial x-rays, dosages 15–20 Gy, overall limit 40 Gy. Over 5–6 sessions in the early postoperative period | • Overall good efficiency rates of adjuvant radiotherapy after keloid excision • Common adverse effects: potential risk of malignant change/carcinogenesis |
Laser therapy | Short-pulsed dye laser (585-nm PDL) with doses ranging from 6.0 to 7.5 J/cm2 (7-mm spot) or from 4.5 to 5.5 J/cm2 (10-mm spot), 2 to 6 treatments every 2 to 6 weeks | • Excellent therapeutic option for the treatment of primarily keloids and younger hypertrophic scars • High recurrence rates with other (ablative) laser techniques for the treatment of keloids |
Emerging Therapies | ||
Interferon | Intralesional injection of INF-α2b (1.5–2 × 106 IU) twice daily over 4 days | • Clinical studies report overall effectiveness • Common adverse effects: flu-like symptoms on injection |
5-FU | Intralesional injection of 5-FU 50 mg/mL | • Overall effective for the treatment of keloids and hypertrophic scars • Common adverse effects: anemia, leucopenia, thrombocytopenia; blood-count monitoring is needed No therapy in pregnant women or patients with bone marrow suppression |