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Evidence-based management of keloids and hypertrophic scars in dermatology

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Abstract

While normal, controlled wound-healing results in scars that are nearly imperceptible, hypertrophic scars (HTS) and keloids are the result of an abnormal wound-healing process that can leave unsightly, difficult-to-treat lesions. While such scars are classically associated with surgical incisions, they may also result from burns or accidental trauma to the skin. Several different measures can be taken to prevent the formation of scars or treat those that have already formed. Prevention focuses on reducing inflammation during the wound-healing process, and minimizing tension in the lesion when appropriate. Treatments range from non-invasive modalities such as pressure therapy, topicals, and symptom management, to invasive methods such as injections, lasers, and even surgery. While some treatments, such as corticosteroid injections, have been used in the treatment of HTS and keloids for decades, other newer therapies have only been described in case reports or are still in early phases of clinical trials. Because optimal scar management will not be the same for every patient, further investigation of newer agents and methods is warranted and may benefit a great number of patients. This paper will review the evidence-based management of scars, including current widely used treatment options and promising newly emerging therapies.

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Fig. 1

Reproduced with permission from Das S, and Baker AB (2016) Biomaterials and Nanotherapeutics for Enhancing Skin Wound Healing. Front Bioeng Biotechnol. 2016;4:82

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Data availability statement

The data that support the findings of this study as well as the references used in generation of this article are openly available in PubMed.

Abbreviations

IL:

Interleukin

EGF:

Epidermal growth factor

PDGF:

Platelet-derived growth factor

TGF-β:

Transforming growth factor beta

CTCF:

Connective tissue growth factor

HTS:

Hypertrophic scar

FST:

Fitzpatrick skin type

VSS:

Vancouver Scar Scale

TAC:

Triamcinolone

Th:

T helper

TAC:

Triamcinolone

RAS:

Renin-angiotensin system

ACE:

Angiotensin-converting enzyme

5-FU:

5-Fluorouracil

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Authors and Affiliations

  1. Georgetown University School of Medicine, Washington, DC, USA

    Emily Y. Kim

  2. MedStar Washington Hospital Center/Georgetown University Dermatology Residency Program, Washington, DC, USA

    Aamir Hussain

  3. Department of Dermatology, Veterans Affairs Medical Center, SUNY Downstate, 800 Poly Place, Brooklyn, NY, 11209, USA

    Amor Khachemoune

  4. Department of Dermatology, Veterans Affairs New York Harbor Healthcare System, Brooklyn, NY, USA

    Amor Khachemoune

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  1. Emily Y. Kim
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EYK performed the literature search and drafted the original work. AH and AK critically revised the work. AH and AK gave final approval of the version to be published.

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Correspondence to Amor Khachemoune.

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Emily Y. Kim, Aamir Hussain, and Amor Khachemoune declare that they have no conflict of interest.

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Kim, E.Y., Hussain, A. & Khachemoune, A. Evidence-based management of keloids and hypertrophic scars in dermatology. Arch Dermatol Res 315, 1487–1495 (2023). https://doi.org/10.1007/s00403-022-02509-x

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