Evidence-Based Review of Current Keloid and Hypertrophic Scar Preventions and Treatments

DOI
  • Ogawa Rei
    Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital
  • Akaishi Satoshi
    Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital
  • Hyakusoku Hiko
    Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital

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  • エビデンスに基づいたケロイド • 肥厚性瘢痕における治療指針

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Description

This paper presents an evidence-based review of previous papers on the treatment and prevention of keloids and hypertrophic scars (HSs). The methodological quality of clinical trials was evaluated, and the baseline characteristics of patients and the interventions that were applied and their outcomes were extracted. Important factors that promote keloid / HS development include mechanical forces acting on the wound, wound infection and foreign body reactions. For HSs, the treatment method that should be used depends on whether scar contractures, especially joint contractures, are present. Small / 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 anti-tumor / immunosuppressive agents (e.g., 5-fluorouracil). Large / 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 / internal agents and make-up (camouflage) therapy, should be administered on a case-by-case basis.

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