Facial Plast Surg 2019; 35(03): 260-266
DOI: 10.1055/s-0039-1688847
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nonsurgical Treatment of Keloids and Hypertrophic Scars

Robert Saddawi-Konefka
1   Surgery (Division of Otolaryngology - Head and Neck Surgery), University of California, San Diego, San Diego, California
,
Deborah Watson
1   Surgery (Division of Otolaryngology - Head and Neck Surgery), University of California, San Diego, San Diego, California
› Author Affiliations
Further Information

Publication History

Publication Date:
12 June 2019 (online)

Abstract

Despite the ubiquitous nature of scar tissue, there is not a single, reliable strategy to prevent or treat excessive scarring. The difficulty in arriving at a universally accepted form of management is multifaceted: there is an incomplete understanding of the complex pathophysiology of scar formation; a lack of common metrics hampers the accurate description of scar quality and characteristics; model systems do not exist for proper investigation in the controlled environment of a laboratory; and there is only limited data from prospective, randomized controlled clinical trials. Accordingly, the management of cutaneous scars is typically based upon the experience from practitioners rather than from evidence-based data. This article will review the pathophysiology of excessive scar formation, define the most common scars—hypertrophic scars and keloids—and discuss the evidence to support the current nonsurgical therapies in use to both prevent and treat excessive scars.

 
  • References

  • 1 Gauglitz GG. Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig Dermatol 2013; 6: 103-114
  • 2 Gurtner GC, Werner S, Barrandon Y, Longaker MT. Wound repair and regeneration. Nature 2008; 453 (7193): 314-321
  • 3 Gold MH, Berman B, Clementoni MT, Gauglitz GG, Nahai F, Murcia C. Updated international clinical recommendations on scar management: part 1--evaluating the evidence. Dermatol Surg 2014; 40 (08) 817-824
  • 4 Gold MH, McGuire M, Mustoe TA. , et al; International Advisory Panel on Scar Management. Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment. Dermatol Surg 2014; 40 (08) 825-831
  • 5 Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg 1999; 104 (05) 1435-1458
  • 6 Tziotzios C, Profyris C, Sterling J. Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures. J Am Acad Dermatol 2012; 66 (01) 13-24 , quiz 25–26
  • 7 Shih B, Garside E, McGrouther DA, Bayat A. Molecular dissection of abnormal wound healing processes resulting in keloid disease. Wound Repair Regen 2010; 18 (02) 139-153
  • 8 Hayashi T, Furukawa H, Oyama A. , et al. A new uniform protocol of combined corticosteroid injections and ointment application reduces recurrence rates after surgical keloid/hypertrophic scar excision. Dermatol Surg 2012; 38 (06) 893-897
  • 9 Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol 2009; 34 (02) 219-223
  • 10 Mustoe TA. Evolution of silicone therapy and mechanism of action in scar management. Aesthetic Plast Surg 2008; 32 (01) 82-92
  • 11 O'Brien L, Pandit A. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2006; (01) CD003826
  • 12 Koc E, Arca E, Surucu B, Kurumlu Z. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Dermatol Surg 2008; 34 (11) 1507-1514
  • 13 Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg 2006; 32 (07) 907-915
  • 14 Hatamipour E, Mehrabi S, Hatamipour M, Ghafarian Shirazi HR. Effects of combined intralesional 5-fluorouracil and topical silicone in prevention of keloids: a double blind randomized clinical trial study. Acta Med Iran 2011; 49 (03) 127-130
  • 15 Agbenorku P. Triple keloid therapy: a combination of steroids, surgery and silicone gel strip/sheet for keloid treatment. Eur J Plast Surg 2000; 23: 150-151
  • 16 Atkinson J-AM, McKenna KT, Barnett AG, McGrath DJ, Rudd M. A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer's skin tension lines. Plast Reconstr Surg 2005; 116 (06) 1648-1656 , discussion 1657–1658
  • 17 Hosnuter M, Payasli C, Isikdemir A, Tekerekoglu B. The effects of onion extract on hypertrophic and keloid scars. J Wound Care 2007; 16 (06) 251-254
  • 18 Chung VQ, Kelley L, Marra D, Jiang SB. Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study. Dermatol Surg 2006; 32 (02) 193-197
  • 19 Anzarut A, Olson J, Singh P, Rowe BH, Tredget EE. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg 2009; 62 (01) 77-84
  • 20 Renò F, Sabbatini M, Lombardi F. , et al. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen 2003; 11 (05) 331-336
  • 21 Chang P, Laubenthal KN, Lewis II RW, Rosenquist MD, Lindley-Smith P, Kealey GP. Prospective, randomized study of the efficacy of pressure garment therapy in patients with burns. J Burn Care Rehabil 1995; 16 (05) 473-475
  • 22 Watson D, Panuganti B. Treating scars in the auricle region. Facial Plast Surg Clin North Am 2017; 25 (01) 73-81
  • 23 Macintyre L, Baird M. Pressure garments for use in the treatment of hypertrophic scars--a review of the problems associated with their use. Burns 2006; 32 (01) 10-15
  • 24 Arno AI, Gauglitz GG, Barret JP, Jeschke MG. Up-to-date approach to manage keloids and hypertrophic scars: a useful guide. Burns 2014; 40 (07) 1255-1266
  • 25 España A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg 2001; 27 (01) 23-27
  • 26 Sanders KW, Gage-White L, Stucker FJ. Topical mitomycin C in the prevention of keloid scar recurrence. Arch Facial Plast Surg 2005; 7 (03) 172-175
  • 27 Haedersdal M, Moreau KER, Beyer DM, Nymann P, Alsbjørn B. Fractional nonablative 1540 nm laser resurfacing for thermal burn scars: a randomized controlled trial. Lasers Surg Med 2009; 41 (03) 189-195
  • 28 Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg 2003; 111 (06) 1841-1852
  • 29 de Oliveira GV, Nunes TA, Magna LA. , et al. Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg 2001; 27 (08) 721-726
  • 30 Berman B, Perez OA, Konda S. , et al. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007; 33 (11) 1291-1302 , discussion 1302–1303
  • 31 Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M. A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg 2005; 116 (04) 1013-1020 , discussion 1021–1022
  • 32 van der Wal MB, van Zuijlen PP, van de Ven P, Middelkoop E. Topical silicone gel versus placebo in promoting the maturation of burn scars: a randomized controlled trial. Plast Reconstr Surg 2010; 126 (02) 524-531
  • 33 Tierney E, Mahmoud BH, Srivastava D, Ozog D, Kouba DJ. Treatment of surgical scars with nonablative fractional laser versus pulsed dye laser: a randomized controlled trial. Dermatol Surg 2009; 35 (08) 1172-1180
  • 34 Steinstraesser L, Flak E, Witte B. , et al. Pressure garment therapy alone and in combination with silicone for the prevention of hypertrophic scarring: randomized controlled trial with intraindividual comparison. Plast Reconstr Surg 2011; 128 (04) 306e-313e
  • 35 Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg 2007; 59 (06) 688-691
  • 36 Emad M, Omidvari S, Dastgheib L, Mortazavi A, Ghaem H. Surgical excision and immediate postoperative radiotherapy versus cryotherapy and intralesional steroids in the management of keloids: a prospective clinical trial. Med Princ Pract 2010; 19 (05) 402-405
  • 37 Aggarwal H, Saxena A, Lubana PS, Mathur RK, Jain DK. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol 2008; 7 (01) 43-49
  • 38 Tredget EE, Shankowsky HA, Pannu R. , et al. Transforming growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b. Plast Reconstr Surg 1998; 102 (05) 1317-1328 , discussion 1329–1330
  • 39 Miller CHT, Maher SG, Young HA. Clinical use of interferon-γ. Ann N Y Acad Sci 2009; 1182: 69-79
  • 40 Malhotra AK, Gupta S, Khaitan BK, Sharma VK. Imiquimod 5% cream for the prevention of recurrence after excision of presternal keloids. Dermatology 2007; 215 (01) 63-65
  • 41 Berman B, Harrison-Balestra C, Perez OA. , et al. Treatment of keloid scars post-shave excision with imiquimod 5% cream: a prospective, double-blind, placebo-controlled pilot study. J Drugs Dermatol 2009; 8 (05) 455-458
  • 42 Cação FM, Tanaka V, Messina MC. Failure of imiquimod 5% cream to prevent recurrence of surgically excised trunk keloids. Dermatol Surg 2009; 35 (04) 629-633
  • 43 Berman B, Garikaparthi S, Smith E, Newburger J. A novel hydrogel scaffold for the prevention or reduction of the recurrence of keloid scars postsurgical excision. J Am Acad Dermatol 2013; 69 (05) 828-830