Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches

Abstract

Cosmetic, functional, and structural sequelae of scarring are innumerable, and measures exist to optimize and ultimately minimize these sequelae. To evaluate the innumerable methods available to decrease the cosmetic, functional, and structural repercussions of scarring, pubMed search of the English literature with key words scar, scar revision, scar prevention, scar treatment, scar remodeling, cicatrix, cicatrix treatment, and cicatrix remodeling was done. Original articles and reviews were examined and included. Seventy-nine manuscripts were reviewed. Techniques, comparisons, and results were reviewed and tabulated. Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable. However, advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach. Comparison studies of the innumerable specific modalities for scar revision and prevention are impossible. Standardization of techniques is lacking. Scarring, the body's natural response to a wound, can create many adverse effects. At this point, the practice of sound, surgical fundamentals still trump the most advanced preventative methods and revision techniques. Advances in medical approaches are available, however, to assist the scarring process, which even the most advanced surgical fundamentals will ultimately lead to. Whether through newer topical therapies, light treatment, or classical surgical intervention, our treatment armamentarium of scars has expanded and will allow us to maximize scar prevention and to minimize scar morbidity.

Hypertrophic scarring: the greatest unmet challenge after burn injury

“…4,11 Management of the wound and careful incision placement along the skin’s natural tension lines can reduce subsequent hypertrophic scarring, enabling the clinician to influence the healing environment through selection of wound covers, and surgical and non-surgical interventions. 4,12 …”

Angiotensin‐converting enzyme inhibitor works as a scar formation inhibitor by down‐regulating Smad and TGF‐β‐activated kinase 1 (TAK1) pathways in mice

“…The predilection for scar formation is affected by a variety of factors (Thomas and Somenek, 2012). Predisposing factors that increase the likelihood of aberrant healing and result in the formation of hypertrophic scars and keloids have been well documented (Thomas and Somenek, 2012;Kerwin et al, 2014;Balaraman et al, 2015;Martin and Nunan, 2015). Annually, there are 100 million patients in the developing world who are left with scars after healing, which results in expensive financial burdens on Healthcare Systems (Bayat et al, 2003).…”

Angiotensin-converting enzyme inhibitor reduces scar formation by inhibiting both canonical and noncanonical TGF-β1 pathways

“…A scar can cause cosmetic problems, but scarring can also result in the loss of joint function or hinder growth in children 8 , 9 . Psychological distress, including anxiety and depression, also often occurs 6 , 8 , 10 , 11 . Therefore, both patients and physicians should welcome even small improvements in scar management.…”