Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods: An Upd
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EDITORIAL
Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods: An Update B. Atiyeh1 • A. Ibrahim1
Published online: 5 August 2020 Ó Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery 2020
Repair of injured skin to its original state is of concern to both patient and treating physician. Multiple cells from different lineages are involved in healing of cutaneous wounds. The process is characterized by a complex and sensitive balance between activation and inhibition of inflammation and is well orchestrated and coordinated by signaling transduction of a diversity of growth factors, cytokines, and extracellular matrix (ECM) components [1, 2]. Unfortunately most skin wound healing following trauma or surgery is imperfect and results in scar formation [1]. Hypertrophic scar (HTS) incidence is 4–16%, and approximately 35% of all surgical skin wounds result after 1 year in HTSs [3]. Though not life threatening, HTSs cause significant functional, cosmetic, and psychological sequelae [1] often overlooked, scars negatively impact to a great extent the individual’s quality of life due to anxiety and depression, loss of self-esteem, stigmatization, and disruption of daily activities [4]. Most described treatment modalities have been proven through extensive use. Though some have achieved acceptance as standard practice, few have been supported by prospective studies with adequate control groups [5]. Review of the vast array of available methods at the time of the initial report demonstrated that most were often inconvenient; besides having occasional undesirable severe side effects with various responses from different patients,
& B. Atiyeh [email protected] 1
Beirut, Lebanon
they generally did not have consistent efficacy [4, 6]. There was thus a need to review with evidence-based approach available scar treatment modalities and try to evaluate their efficacy. Various modalities were identified including application of dynamic and static mechanical forces, pressure garments, light-based therapies, interferon, cryosurgery, radiation, application of topical gels and ointments, and administration of various injectables, including 5-fu, corticosteroids, immune modulators, and hyaluronidases; all have demonstrated limited efficacy [5, 6]. In addition, various emerging cell-based approaches were identified to target different stages of wound healing in an attempt to prevent scar development, but none of these have been entirely successful [6]. An effort was made to distinguish between prophylactic measures and actual treatment methods as well as those modalities with clearly proven efficiency and anecdotal reports about therapies of doubtful benefits [5]. This review concluded that the only treatments for which sufficient evidence existed for the management of a wide variety of abnormal scars to make evidence-based recommendations were silicon gel sheeting and intralesional corticosteroids injectio
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