Table 4.
New updated recommendations for excessive scar management.
PREVENTION | HTS | Basic scar care | Hydration/topical moisturizer | |
KELOID | Massage | |||
UV protection (sunscreen) | ||||
Non-concerned patient/low-cost measures | Hypoallergenic microporous paper tape | |||
Concerned patient | SGS | |||
TREATMENT | HTS | With contractures | Surgery to release scar | |
Without contractures | First line | SGS 6 w and optional lasera | ||
Second line | TAC + optional cryotherapy combinedb | |||
Third line | Laserb (PDL or fractional laser therapy) | |||
KELOID | First line | TAC + 5-FU + laser therapy + SGS | ||
Second line | Surgery + aforementioned conservative measures + optional additional brachytherapy |
Note: These are just general recommendations. Each scar has to be studied in a case-by-case basis.
Abbreviations: HTS, hypertrophic scar; SGS, silicone gel sheeting; TAC, triamcinolone acetonide.
And/or pressure garments for 6–12 months, mainly in burn scars and other special cases; regarding laser, it was initially reserved as third-line therapy, but due to promising clinical results despite few scientific evidence, some consider to start with laser as well, which may help to enhance the efficacy of further treatments (such as TAC delivery). Cost-effectiveness studies should be performed first to confirm.
In the case of major burns and large scars, laser would be second line strategy, as TAC is usually scarcely used.