The most current algorithms for the treatment and prevention of hypertrophic scars and keloids.
BACKGROUND
Previous reports on the treatment of hypertrophic scars and keloids have not described clear algorithms for multimodal therapies. This article presents an evidence-based review of previous articles and proposes algorithms for the treatment and prevention of hypertrophic scars and keloids.


METHODS
The methodologic quality of the clinical trials was evaluated, and the baseline characteristics of the patients and the interventions that were applied and their outcomes were extracted.


RESULTS
Important factors that promote hypertrophic scar/keloid development include mechanical forces on the wound, wound infection, and foreign body reactions. For keloids, the treatment method that should be used depends on whether scar contractures (especially joint contractures) are present and whether the keloids are small and single, or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (which includes radiation or corticosteroid injections) or by nonsurgical monotherapy (which includes corticosteroid injections, cryotherapy, laser, and antitumor/immunosuppressive agents such as 5-fluorouracil). Large and multiple keloids are difficult to treat radically and are currently only treatable by multimodal therapies that aim to relieve symptoms. After a sequence of treatments, long-term follow-up is recommended. Conservative therapies, which include gel sheeting, taping fixation, compression therapy, external and internal agents, and makeup (camouflage) therapy, should be administered on a case-by-case basis.


CONCLUSIONS
The increase in the number of randomized controlled trials over the past decade has greatly improved scar management, although these studies suffer from various limitations. The hypertrophic scar/keloid treatment algorithms that are currently available are likely to be significantly improved by future high-quality clinical trials.
Ogawa
Rei
R
Boston, Mass.; and Tokyo, Japan From the Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, and the Department of Plastic Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital.
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000465:Algorithms; D001458:Bandages; D017439:Cicatrix, Hypertrophic / Q000517:prevention & control / Q000601:surgery / Q000628:therapy; D003131:Combined Modality Therapy; D003286:Contracture / Q000601:surgery; D017679:Cryotherapy; D019317:Evidence-Based Medicine; D005549:Foreign-Body Reaction / Q000628:therapy; D006801:Humans; D007627:Keloid / Q000517:prevention & control / Q000601:surgery / Q000628:therapy; D053685:Laser Therapy; D011878:Radiotherapy; D016032:Randomized Controlled Trials as Topic; D013518:Surgery, Plastic
D000305:Adrenal Cortex Hormones