The Most Current Algorithms for the
Treatment and Prevention of
Hypertrophic Scars and Keloids: A
2020 Update of the Algorithms
Published 10 Years Ago
Bibliography staff of the 25/04/2023
Mohamed Taieb Kassab Institute
Presented by: Zmorda EL MESSIOUI
Plan
• Introduction
• methodology
• Summary of the main results
• Conclusion
Introduction
• Literature review Update: Rei Ogawa, M.D., Ph.D. (2010).
• Comprehensive, evidence-based algorithms : management of
hypertrophic and keloid scars.
Methodology
• All studies : evaluated for methodologic quality.
• Baseline characteristics of patients.
• Types of interventions and outcomes.
• Systematic reviews, meta-analyses, and comprehensive reviews.
Summary of the main ideas
• What are HS and KS ?
1.06 % of 378 KS/KS were
• What are the risk factors of HS and KS ?
actually other diseases !
Summary of the main ideas
• What are HS and KS ?
• What are the risk factors of HS and KS ?
Local
Systemic
Genetic
lifestyle
High risk areas local
RF
Scapular area
Anterior chest (sternal area +++)
Lower abdomen
Major joints
Systemic RF
• Oestrogen
• Hypertension
• Hypercytokinemic diseases
Genetic RF
• Ethnicity: black > Asian > Caucasian
• Family history
• Single-nucleotide polymorphism
• Some genetic diseases (Rubinstein-Taybi syndrome/ Multiple hereditary exostoses)
lifestyle
• Strenuous wound-stretching activities: workout/ manual labor
• Certain diets (hot food) ?
• Hot baths
TTT of hypertrophic scars
• Compression therapy
• Gel sheets
• Corticosteroid injection
• Corticosteroid tape and plaster
Scar massage ?!
• Corticosteroid ointment and cream
• Laser : pulse-dye / Neodimium-YAG
• Surgery
• Other ttt: fat grafting/ cryotherapy/ 5-FU injections+- triamcinolone
acetonide/ Intralesional Botox type A/ bleomycin injections
TTT of hypertrophic scars
• Compression therapy:
Meta-analysis (12 randomized controlled trials):
o 15- to 25-mmHg compression therapy
o improves burn and hypertrophic scar thickness, erythema, and hardness.
o May promote wound healing
TTT of hypertrophic scars: Gel
sheets
Continuous gel sheeting improves hypertrophic scar maturation.
Silicone and hydrocolloid matrix gel sheets reduce hypertrophic scar dimensions equally well.
Instructional handouts and videotapes increase gel sheet effectiveness.
TTT of hypertrophic scars:
Corticosteroid injection
• 50 to 100 % regression of HS/KS.
• Triamcinolone acetonide at doses of 2.5 to 40 mg/site .
• inflammatory cytokine production.
• Side effects: pain, systemic , and local side effects (e.g., skin thinning and atrophy, steroid acne,
capillary dilatation, and hypopigmentation).
TTT of hypertrophic scars
• Corticosteroid tape and plaster
60 hypertrophic scar and keloid patients : treated with fludroxycortide (weak steroid) tape.
=> 20 % adults and 80 % children exhibited improved scar elevation and erythema and pruritus after 12 months.
Tape and plaster should be used continuously as early as possible for at least 3 months.
• Corticosteroid ointment and cream
should be applied four times daily : patient education
TTT of hypertrophic scars: Laser
• Laser : pulsed-dye / Neodimium-YAG
Pulsed-dye laser significantly reduces hypertrophic scar erythema and pruritus.
Neodymium:yttrium-aluminum-garnet laser (532/1064 nm): similar effects.
Nonablative/ ablative carbon dioxide fractional lasers have no beneficial effects.
Fully ablative laser therapy is not recommended for pathologic scars (high
recurrence).
TTT of hypertrophic scars:
Surgery
HS/KS near or on a joint => joint dysfunction => should be released surgically.
Small and linear hypertrophic scars : complete resection.
Tension-releasing techniques: Z-plasty, W-plasty, local flaps.
The suturing method : tensile-reduction sutures.
TTT of hypertrophic scars: Scar
Massage
A meta-analysis of 10 randomized controlled trials concluded
that the supporting evidence is weak.
The author advises caution regarding massage
therapy.
Scar massage in high-risk patients should be avoided.
TTT of Keloid scars
• Gel sheets
• Corticosteroid injection
• Corticosteroid tape and plaster Number and
size of KS+++
• Corticosteroid ointment and cream
• cryotherapy
• Antitumor and immunosuppressive agents: 5-FU / Bleomycin
• Surgery
• Radiation therapy
TTT of Keloid scars
• Single/ small keloids: conservative therapy.
• Thick, large, multiple keloids : assessed for surgery + adjuvant therapy
• Scar massage, ablative lasers, and surgical monotherapy : should be
avoided.
• Small keloids: radically resected.
• Large and multiple keloids: partial and
Surgical TTT core excision
• Radical resection => always combined
of Keloid with adjuvant therapies
scars • surgery alone = 45 to 100 %
recurrence !
• Close follow-up => early detection and
Long-term treatment of small recurrences.
follow-up • 18 to 24 months +++
• Follow-up can stop when the scar
is flat and soft
• Makeup or camouflage therapies
Conclusion
• Recently, many high-quality studies about the management of pathologic scars, have been
published worldwide.
• Algorithms simplifiying management of HS/KS have been successfully established.
• Further trials and studies would optimise prevention and treatment according to ethnic differences
might become a reality.
