Table 2.

Hypertrophic scars and keloids: current therapeutic strategies.

Treatment	Use	Indications, efficiency and comments
Prophylaxis
Pressure therapy	Continuous pressure (15–40 mmHg) for at least 23 h/d ≥6 months of scar healing	Prophylaxis of hypertrophic burn scars, ear keloids (postexcision) Controversial success Reduced compliance due to frequent patient discomfort
Silicone gel sheeting	≥12 h/d for ≥2 months beginning 2 weeks after wound healing	Prophylaxis for the development of hypertrophic scars and keloids No effects on mature keloids and hypertrophic scars
Silicone gel	Twice daily for 2 months beginning 2 weeks after wound closure
Flavonoids	For example, Contractubex gel (Merz Pharma, Frankfurt, Germany), Mederma Skin Care Gel (Merz, Pharmaceuticals, Greensboro, NC, USA). Twice daily for 4 to 6 months beginning 2 weeks after wound closure	Limited to prophylaxis of hypertrophic scar and keloid development
Current therapies
Corticosteroids	Intralesional injections of TAC (10–40 mg/mL), several treatments once or twice a month	First-line therapy for keloids, second-line therapy for hypertrophic scars Combination with surgery, PDL and cryotherapy Common adverse effects: skin and subcutaneous fat atrophy, telangiectasias
Cryotherapy	Contact/spray freezing with liquid nitrogen using 10–20 s freeze-thaw cycles	Overall effective for hypertrophic scars, for keloids combination with triamcinolone acetonide injections recommended Limited to management of smaller scars Common adverse effects: blistering and pain
Scar revision	Excision with linear, tension-free closure, split- or full-thickness skin grafting, z-plasty, w-plasty	Efficacious for therapy of hypertrophic scarring Recurrence rates of 45–100% after keloid excision without adjuvant therapy
Radiotherapy	Superficial x-rays, dosages 15–20 Gy, overall limit 40 Gy. Over 5–6 sessions in the early postoperative period	Overall good efficiency rates of adjuvant radiotherapy after keloid excision Common adverse effects: potential risk of malignant change/carcinogenesis
Laser therapy	Short-pulsed dye laser (585-nm PDL) with doses ranging from 6.0 to 7.5 J/cm2 (7-mm spot) or from 4.5 to 5.5 J/cm2 (10-mm spot), 2 to 6 treatments every 2 to 6 weeks	Excellent therapeutic option for the treatment of primarily keloids and younger hypertrophic scars High recurrence rates with other (ablative) laser techniques for the treatment of keloids
Emerging Therapies
Interferon	Intralesional injection of INF-α2b (1.5–2 × 106 IU) twice daily over 4 days	Clinical studies report overall effectiveness Common adverse effects: flu-like symptoms on injection
5-FU	Intralesional injection of 5-FU 50 mg/mL	Overall effective for the treatment of keloids and hypertrophic scars Common adverse effects: anemia, leucopenia, thrombocytopenia; blood-count monitoring is needed No therapy in pregnant women or patients with bone marrow suppression