Table 2.

Characteristics of the main non-surgical methods for treatment of hypertrophic burn scars

Treatment modality	Mechanisms of action (reference)	Effects (reference)	Possible adverse effects/ Disadvantages (reference)	Other considerations (reference)
Silicone gel sheets	Collagen remodeling by local increasing of oxygen and temperature, hydration, chemical effects, increasing number of mast cells, and polarizing scar tissue (7)	Increased elasticity, decreased pruritus and erythema, decreased scar thickness and height (42), especially effective in fresh scars (47),	Folliculitis, lack of efficacy on mature scars (47)	Effectiveness in preventing burn scars is conflicting (46)
Compression garments	Inhibition of TGF-β1 secretion and thereby attenuating fibroblast activity (42), Reduction of collagen production through reducing blood flow at the site of injury and thereby reducing oxygen and nutrients transfer (47)	Decreased scar thickness and hardness, decreased erythema (42)	Low patient compliance and adherence (<40%) because of discomfort, appearance, and movement difficulties (42)	Efficacy is highly depending on the anatomic position of the injured are (47)
			Skin rash, erosion, pruritus, swelling, skeletal deformities (47)
Intralesional corticosteroid injections	Inhibition of inflammation and immunosuppression, vasoconstriction, inhibition of fibroblast and keratinocyte proliferation (47)	Increased pliability, decreased height and volume of scars, decreased pain and pruritus (46, 47)	High rate of adverse effects (up to 60%) including hypopigmentation, skin atrophy, telangiectasias, rebound effects, ineffectiveness and injection pain.	Improved efficacy if combined with other therapies, decreased adverse effects in combination with 5-FU (47)
			Variable response rate (50-100%), possibility of recurrence (9-50%) (47)
Laser and light therapy	Based on the type of laser: collagen remodeling, induction of necrosis in the target capillaries and therefore reduction of vascularity (46)	Increased pliability, decreased erythema, scar height and volume, pain, pruritus, color, and abnormal texture (46)
Fat grafting	Efficacy is mainly attributed to adipose-derived stem cells that may change fibroblast ECM production (46)	Enhancement of wound closure, increased pliability, decreased fibrosis, decreased scar height and skin hardness (46)
Interferons (α, β, γ)	Enhancement of collagen breakdown, inhibition of TGF-β and fibrosis by IFN-γ, inhibition of proliferation by IFN-α2b (47)	Improved appearance of scars, decreased recurrence of keloid scars (47)	Painful injections, Flu-like adverse effects (47)	An expensive therapy, but a promising method to treat extreme scarring (47)