Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods
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REVIEW
Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods Bishara S. Atiyeh
Received: 8 December 2006 / Accepted: 5 January 2007 Ó Springer Science+Business Media, LLC 2007
Abstract Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment. Keywords Hypertrophic scar Keloid Scar management
This article is being reprinted for ISAPS 50th Anniversary Special Issue. B. S. Atiyeh (&) Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon e-mail: [email protected]
Cutaneous wounds inevitably heal with scars. For some individuals, the normal wound-healing process becomes derailed, resulting in an overabundance of scar tissue [17, 138]. Moreover, individuals with deep burn injuries are at a high risk for hypertrophic scarring, which is a serious cause of long-term impairment and disability [64]. Hypertrophic scars, often viewed as aesthetically displeasing [17], are among the most common and frustrating problems after injury, causing functional and cosmetic deformities, discomfort, itching, pain, psychological stress, and patient dissatisfaction, possibly affecting joint range of movement and reducing functional performance [17, 18, 154, 208]. The quality of life experienced by patients with keloid and hypertrophic scarring also can be impaired [29]. Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix (ECM) proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis [122, 173, 188]. In the normal healing process after r
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