Scars: Updated Management Recommendations

Abnormal scarring is troublesome for patients, for both its cosmetic inelegance and pain.

Updated International Clinical Recommendations on Scar Management (UICRSM) grades the two basic types of scars — hypertrophic and keloid – using a standard scale.

Hypertrophic scars, more common in lighter skinned people, frequently occur after surgery or burns. Keloid scars, usually prevalent in people with darker skin, extend beyond the original wound’s boundaries and often reoccur if removed. Scarring is still poorly understood, but the science behind the art of scar management is growing.

The journal Current Opinion in Otolaryngology and Head and Neck Surgery has published an update covering the UICRSM’s International Clinical Recommendations on Scar Management ahead-of-print. These recommendations defined patients at high risk of abnormal scarring as those with histories of hypertrophic or keloid scars, darker skin pigmentation, and scars that cross-relaxed skin tension lines.

According to experts, the cornerstone of scar prevention is good surgical technique and wound management. The recommendations suggested using silicone-based products as the first interventions to prevent and treat hypertrophic and keloid scars, since they can be used with or without intralesional corticosteroids.

Patients will need to use these products for two months and at least 12 hours daily during that time. Microporous paper tape, another conservative treatment, also has some benefit, especially in high-tension scars.

Intralesional corticosteroids are preferred for keloids and hypertrophic scars, but these updated recommendations move them to second-line therapy. They can be considered at two months if the scar fails to respond to silicone. Lesions that fail to respond to intralesional corticosteroids sometimes respond to 5-fluorouracil tattooing.

The report also recommended laser therapy, with low-level evidence supporting the use of pulse dye lasers and ablative fractional lasers. Surgical revision of scars was considered a last resort treatment.

The researchers wanted to highlight that no gold standard exists for hypertrophic scar and keloid prevention and treatment.

These updated clinical recommendations provide a stepwise algorithm based on the scar’s characteristics and responsiveness. When scars are severe, healthcare providers should consider combination therapy (including steroid injections, 5-fluorouracil, and pulse dye laser).