title: Evaluating evidence for atrophic scarring treatment modalities.
abstract: BACKGROUND
  Atrophic scars cause significant patient morbidity. Whilst there is evidence to guide treatment, there does not appear to be a systematic review to analyse the efficacy of treatment options.
  
  
  OBJECTIVE
  To retrieve all evidence relating to atrophic scar treatment and evaluate using the Clinical Evidence GRADE score in order to allow clinicians to make evidence-based treatment choices.
  
  
  METHODS
  Searches were performed in Medline, EMBASE, CINHL and Cochrane to identify all English studies published evaluating treatment of atrophic scars on adults excluding journal letters. Each study was allocated a GRADE score based on type of study, quality, dose response, consistency of results and significance of results. The end score allowed categorisation of evidence into high, moderate, low or very low quality.
  
  
  RESULTS
  A total of 41 studies were retrieved from searches including randomised controlled trials, observational studies, retrospective analyses and case reports of which 7% were allocated a high-quality score, 10% a moderate score, 7% a low score and 75% a very low score. Treatment modalities included ablative laser therapy, non-ablative laser therapy, autologous fat transfer, dermabrasion, chemical peels, injectables, subcision, tretinoin iontophoresis and combination therapy.
  
  
  CONCLUSIONS
  There is a paucity of good-quality clinical evidence evaluating treatment modalities for atrophic scarring. Evidence supports efficacy of laser, surgery and peel therapy. Further biomolecular research is required to identify targeted treatment options and more randomised controlled trials would make the evidence base for atrophic scar treatment more robust.
authors.affiliation: Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK.
authors.forename: Lopa
authors.initials: L
authors.lastname: Patel
authors.affiliation: Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK.
authors.forename: Duncan
authors.initials: D
authors.lastname: McGrouther
authors.affiliation: Department of Plastic Surgery and Burns Care, University Hospitals of South Manchester, Wythenshawe, Manchester M23 9LT, UK.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Chakrabarty
keywords: GRADE score; atrophic scarring; evidence; treatment