Management of hypertrophic scars in adults: A systematic review and meta‐analysis

Abstract

Hypertrophic scars (HTS) are elevated scars which occur due to abnormalities in wound healing after injury and may be associated with pain, pruritus and functional impairment. Despite multiple available treatment options, there is no universal approach to treating HTS. We searched the Web of Science (Core Collection), MEDLINE and EMBASE databases. Title, abstract and full-text screening, along with data extraction, were performed in duplicate. Risk of bias was assessed using the Cochrane risk-of-bias tool. The Vancouver Scar Scale (VSS) scores and mean differences were used for meta-analysis. We screened 3800 abstracts and included 34 randomised controlled trials evaluating treatments for HTS in adults. Silicone and laser modalities improved VSS scores by 5.06 (95% CI: 6.78, 3.34) and 3.56 (95% CI: 5.58, 1.54), respectively. Intralesional triamcinolone combined with silicone or 5-fluorouracil was superior to intralesional triamcinolone monotherapy. Limitations of this study include exclusion of studies which did not utilise VSS, and pooling of studies based on common modalities. Further studies are needed to examine the efficacy of existing and emerging treatment modalities for HTS. Our study supports the treatment of HTS in adults with silicone gel or sheets, injected triamcinolone (preferably combined with 5-fluorouracil or silicone products), pulsed dye laser and fractionated CO 2 laser.

Clinical efficacy of ablative laser combined with pulsed dye laser in the treatment of pathological scars: A systematic review and meta‐analysis

“…Compared with normal scars, keloids and hypertrophic scars are collectively called pathological scars. 2,4 Surgical treatment whittles scar stimulation by reducing wound tension, but recurrence is prevalent. Nonsurgical or postoperative adjuvant treatment methods supposedly include the consumption of silica gel or silica gel tablets and injecting triamcinolone acetonide (preferably in conjunction with 5-fluorouracil or silica gel products).…”

“…These scars may be familiar, causing irritation, movement difficulties, loss of regular and cosmetic function, and severe psychological distress 1 . Because the cellular and molecular mechanisms are complex and need to be fully understood, there is reportedly no satisfactory approach to treating or limiting pathological scarring 2 . Skin wound healing consists of four main stages: hematoma formation, inflammation, new tissue formation, and remodelling.…”

“…Excessive synthesis and deposition of extracellular matrix (ECM) tend to result in an excess of collagen and calcinosis, along with increased scar matrix remodelling and stiffness. Compared with normal scars, keloids and hypertrophic scars are collectively called pathological scars 2,4 …”

A prospective study to evaluate the treatment effect of pulsed dye laser on thyroidectomy hypertrophic scars using 3D imaging analysis

“…6,7 Various modalities have been used to improve the appearance of postsurgical HSs, such as topical agents, intralesional corticosteroid (ICS) injections, laser procedures, compression therapy using elastic bandages, cryosurgery, and surgical scar revision. [8][9][10] All these treatment methods have their own limitations and their efficacy is still not established. The 595 nm pulsed dye laser (PDL), an effective modality for reducing scar erythema, volume, and pruritus, is the most preferred and well-tolerated treatment option because of its convenience and safety.…”

“…Various modalities have been used to improve the appearance of postsurgical HSs, such as topical agents, intralesional corticosteroid (ICS) injections, laser procedures, compression therapy using elastic bandages, cryosurgery, and surgical scar revision 8–10 . All these treatment methods have their own limitations and their efficacy is still not established.…”