Continuing medical education
Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics: Part II. Strategies to reduce scar formation after dermatologic procedures

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The evidence base underpinning most traditional scar reduction approaches is limited, but some of the novel strategies are promising and accumulating. We review a number of commonly adopted strategies for scar reduction. The outlined novel agents are paradigmatic of the value of translational medical research and are likely to change the scenery in the much neglected but recently revived field of scar reduction therapeutics.

Section snippets

Antiscarring strategies

A cutaneous scar results from overgrowth of fibrous tissue after damage to the skin after injury or surgery and represents an exuberant healing response.1 The type of scar depends on how exuberant the healing response is, with hypertrophic scars not extending beyond the wound borders and keloids extending. The former are clinically more favorable than the latter because they are more amenable to treatment and often even regress spontaneously.2 Both types of cutaneous scarring are underpinned by

Practical prophylactic considerations

Key points

  1. •

    Identifying high risk is paramount to preventing hypertrophic scarring after dermatologic procedures

  2. •

    Certain high-pressure body sites are more likely to show exaggerated scarring, and patients of Afro-Caribbean descent and those with personal or family history of scarring are at increased risk of engaging in such a response

  3. •

    Minimizing skin tension and the inflammatory response after surgery by using the appropriate materials and ascertaining clean surgery and good wound care are simple practical

Nonsurgical scar reduction strategies

Key points

  1. •

    There are numerous antiscarring agents available over the counter, including silicone dressings, onion extract, and vitamin E–based remedies, none of which are supported by a sufficient evidence base

  2. •

    There is some evidence base underpinning the use of intralesional corticosteroids, 5-fluorouracil, and bleomycin

There is a multitude of commonly used over the counter scar treatment products that have little evidence-based efficacy.20, 21 Among these, silicone dressings, onion extract, and vitamin

Surgery, lasers, and radiation

Key points

  1. •

    The surgical revision of hypertrophic scars is rarely performed because of high recurrence rates, but cryotherapy has been widely used with success

  2. •

    Lasers are widely used in practice, and pulsed-dye laser therapy has shown efficacy, has a low-risk adverse effect profile, and is becoming increasingly popular as a pre- and postsurgery scar reduction modality

  3. •

    Radiotherapy tends to be reserved as a late resort for resistant scars and is used sparely because of concerns over carcinogenic potential

Innovative medical approaches

Key points

  1. •

    Avotermin, human recombinant interleukin-10, and to a lesser extent mamnose-6-phosphate are novel agents showing promising results in randomized controlled trials and are likely to change practice when they become commercially available

  2. •

    Insulin, mitomycin C, topical tamoxifen, systemic methotrexate, topical imiquimod, retinoic acid, botulinum toxin A, calcineurin inhibitors, and calcium channel blockers have been tested only sporadically and in small-scale studies (some randomized)

  3. •

    More extensive

Conclusion

It should be noted that lack of adequate evidence does not necessarily imply evidence of inadequacy. The present review is not an exhaustive account of evidence-based scar reduction strategies. The selectively discussed conventional modalities are widely available and commonly used, and there is some evidence in support of their use. Each patient is nonetheless different, and the practicing dermatologist must formulate a treatment strategy having considered guidelines on a par with personal

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