Skip to main content

Scarring and Scar Management

  • Chapter
  • First Online:
Handbook of Burns Volume 1
  • 1756 Accesses

Abstract

Scarring is the result of an injury of the deep portion of the dermis. It is commonly caused through elective or emergency surgery, accidental or deliberate trauma or through different dermatological afflictions. While most scars are inconspicuous, pathological forms of scarring can greatly influence the lives of affected patients. They are known for their aesthetically disfiguring properties, significant impairment of function, negative impact on quality of life as well as burdensome symptoms like pronounced pain and pruritus. To alleviate these bothersome symptoms and to improve the affected patients’ physical and psychological well-being, physicians require in-depth knowledge about the pathophysiology of scarring as well as effective options for scar prophylaxis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Poetschke J, Gauglitz GG. Current options for the treatment of pathological scarring. J Dtsch Dermatol Ges. 2016;14:467–77.

    PubMed  Google Scholar 

  2. Gauglitz GG. Management of keloids and hypertrophic scars: current and emerging options. Clin Cosmet Investig Dermatol. 2013;6:103–14.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17:113–25.

    Article  CAS  PubMed  Google Scholar 

  4. Reinholz M, Poetschke J, Schwaiger H, Epple A, Ruzicka T, Gauglitz GG. The dermatology life quality index as a means to assess life quality in patients with different scar types. J Eur Acad Dermatol Venereol. 2015;29:2112–9.

    Article  CAS  PubMed  Google Scholar 

  5. Tuan TL, Nichter LS. The molecular basis of keloid and hypertrophic scar formation. Mol Med Today. 1998;4:19–24.

    Article  CAS  PubMed  Google Scholar 

  6. Lewis WH, Sun KK. Hypertrophic scar: a genetic hypothesis. Burns. 1990;16:176–8.

    Article  CAS  PubMed  Google Scholar 

  7. Deitch EA, Wheelahan TM, Rose MP, Clothier J, Cotter J. Hypertrophic burn scars: analysis of variables. J Trauma. 1983;23:895–8.

    Article  CAS  PubMed  Google Scholar 

  8. Niessen FB, Spauwen PH, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999;104:1435–58.

    Article  CAS  PubMed  Google Scholar 

  9. Bayat A, Arscott G, Ollier WE, McGrouther DA, Ferguson MW. Keloid disease: clinical relevance of single versus multiple site scars. Br J Plast Surg. 2005;58:28–37.

    Article  CAS  PubMed  Google Scholar 

  10. Gangemi E, Gregori D, Berchialla P, et al. Epidemiology and risk factors for pathologic scarring after burn wounds. Arch Facial Plast Surg. 2008;10:93–102.

    Article  PubMed  Google Scholar 

  11. Slemp AE, Kirschner RE. Keloids and scars: a review of keloids and scars, their pathogenesis, risk factors, and management. Curr Opin Pediatr. 2006;18:396–402.

    Article  PubMed  Google Scholar 

  12. Tredget EE, Nedelec B, Scott PG, Ghahary A. Hypertrophic scars, keloids, and contractures. The cellular and molecular basis for therapy. Surg Clin North Am. 1997;77:701–30.

    Article  CAS  PubMed  Google Scholar 

  13. Szulgit G, Rudolph R, Wandel A, Tenenhaus M, Panos R, Gardner H. Alterations in fibroblast alpha1beta1 integrin collagen receptor expression in keloids and hypertrophic scars. J Invest Dermatol. 2002;118:409–15.

    Article  CAS  PubMed  Google Scholar 

  14. Kose O, Waseem A. Keloids and hypertrophic scars: are they two different sides of the same coin? Dermatol Surg. 2008;34:336–46.

    CAS  PubMed  Google Scholar 

  15. Bock O, Yu H, Zitron S, Bayat A, Ferguson MW, Mrowietz U. Studies of transforming growth factors beta 1-3 and their receptors I and II in fibroblast of keloids and hypertrophic scars. Acta Derm Venereol. 2005;85:216–20.

    CAS  PubMed  Google Scholar 

  16. Wynn TA. Fibrotic disease and the T(H)1/T(H)2 paradigm. Nat Rev Immunol. 2004;4:583–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Brown JJ, Bayat A. Genetic susceptibility to raised dermal scarring. Br J Dermatol. 2009;161:8–18.

    Article  CAS  PubMed  Google Scholar 

  18. Mustoe TA, Cooter RD, Gold MH, Hobbs FD, Ramelet AA, Shakespeare PG, et al. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–71.

    Article  PubMed  Google Scholar 

  19. Tajirian AL, Goldberg DJ. A review of sutures and other skin closure materials. J Cosmet Laser Ther. 2010;12:296–302.

    Article  PubMed  Google Scholar 

  20. Regula CG, Yag-Howard C. Suture products and techniques: what to use, where, and why. Dermatol Surg. 2015;41(Suppl 10):S187–200.

    Article  CAS  PubMed  Google Scholar 

  21. Baur PS, Larson DL, Stacey TR, Barratt GF, Dobrkovsky M. Ultrastructural analysis of pressure-treated human hypertrophic scars. J Trauma. 1976;16:958–67.

    Article  CAS  PubMed  Google Scholar 

  22. Reno F, Sabbatini M, Lombardi F, Stella M, Pezzuto C, Magliacani G, et al. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen. 2003;11:331–6.

    Article  PubMed  Google Scholar 

  23. Van den Kerckhove E, Stappaerts K, Fieuws S, Laperre J, Massage P, Flour M, et al. The assessment of erythema and thickness on burn related scars during pressure garment therapy as a preventive measure for hypertrophic scarring. Burns. 2005;31:696–702.

    Article  PubMed  Google Scholar 

  24. Candy LH, Cecilia LT, Ping ZY. Effect of different pressure magnitudes on hypertrophic scar in a Chinese population. Burns. 2010;36:1234–41.

    Article  PubMed  Google Scholar 

  25. Anzarut A, Olson J, Singh P, Rowe BH, Tredget EE. The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. J Plast Reconstr Aesthet Surg. 2009;62:77–84.

    Article  PubMed  Google Scholar 

  26. Anthonissen M, Daly D, Janssens T, Van den Kerckhove E. The effects of conservative treatments on burn scars: a systematic review. Burns. 2016;42(3):508–18.

    Article  PubMed  Google Scholar 

  27. Kadouch DJ, van der Veer WM, Mahdavian Delavary B, Kerkdijk D, Niessen FB. Therapeutic hotline: an alternative adjuvant treatment after ear keloid excision using a custom-made methyl methacrylate stent. Dermatol Ther. 2010;23:686–92.

    Article  PubMed  Google Scholar 

  28. Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg. 2011;128:431–9.

    Article  CAS  PubMed  Google Scholar 

  29. Bianchi FA, Roccia F, Fiorini P, Berrone S. Use of patient and observer scar assessment scale for evaluation of facial scars treated with self-drying silicone gel. J Craniofac Surg. 2010;21:719–23.

    Article  PubMed  Google Scholar 

  30. Cassuto DA, Scrimali L, Sirago P. Treatment of hypertrophic scars and keloids with an LBO laser (532 nm) and silicone gel sheeting. J Cosmet Laser Ther. 2010;12:32–7.

    Article  PubMed  Google Scholar 

  31. Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol. 2014;28:1025–33.

    Article  CAS  PubMed  Google Scholar 

  32. Rhee SH, Koh SH, Lee DW, Park BY, Kim YO. Aesthetic effect of silicone gel on surgical scars in Asians. J Craniofac Surg. 2010;21:706–10.

    Article  PubMed  Google Scholar 

  33. Sakuraba M, Takahashi N, Akahoshi T, Miyasaka Y, Suzuki K. Use of silicone gel sheets for prevention of keloid scars after median sternotomy. Surg Today. 2011;41:496–9.

    Article  PubMed  Google Scholar 

  34. O’Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013; CD003826.

    Google Scholar 

  35. Gold MH, Berman B, Clementoni MT, Gauglitz GG, Nahai F, Murcia C. Updated international clinical recommendations on scar management: part 1-evaluating the evidence. Dermatol Surg. 2014;40:817–24.

    CAS  PubMed  Google Scholar 

  36. Gold MH, McGuire M, Mustoe TA, Pusic A, Sachdev M, Waibel J, et al. Updated international clinical recommendations on scar management: part 2-algorithms for scar prevention and treatment. Dermatol Surg. 2014;40:825–31.

    CAS  PubMed  Google Scholar 

  37. Nast A, Eming S, Fluhr J, Fritz K, Gauglitz G, Hohenleutner S, et al. German S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids). J Dtsch Dermatol Ges. 2012;10:747–62.

    PubMed  Google Scholar 

  38. Phan TT, Lim IJ, Sun L, Chan SY, Bay BH, Tan EK, et al. Quercetin inhibits fibronectin production by keloid-derived fibroblasts. Implication for the treatment of excessive scars. J Dermatol Sci. 2003;33:192–4.

    Article  CAS  PubMed  Google Scholar 

  39. Phan TT, Lim IJ, Chan SY, Tan EK, Lee ST, Longaker MT. Suppression of transforming growth factor beta/smad signaling in keloid-derived fibroblasts by quercetin: implications for the treatment of excessive scars. J Trauma. 2004;57:1032–7.

    Article  CAS  PubMed  Google Scholar 

  40. Chanprapaph K, Tanrattanakorn S, Wattanakrai P, Wongkitisophon P, Vachiramon V. Effectiveness of onion extract gel on surgical scars in Asians. Dermatol Res Pract. 2012;2012:212945.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Zurada JM, Kriegel D, Davis IC. Topical treatments for hypertrophic scars. J Am Acad Dermatol. 2006;55:1024–31.

    Article  PubMed  Google Scholar 

  42. Arno AI, Gauglitz GG, Barret JP, Jeschke MG. Up-to-date approach to manage keloids and hypertrophic scars: a useful guide. Burns. 2014;40:1255–66.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002;47:S209–11.

    Article  PubMed  Google Scholar 

  44. Chuangsuwanich A, Gunjittisomram S. The efficacy of 5% imiquimod cream in the prevention of recurrence of excised keloids. J Med Assoc Thai. 2007;90:1363–7.

    PubMed  Google Scholar 

  45. Stashower ME. Successful treatment of earlobe keloids with imiquimod after tangential shave excision. Dermatol Surg. 2006;32:380–6.

    CAS  PubMed  Google Scholar 

  46. Shin JY, Yun SK, Roh SG, Lee NH, Yang KM. Efficacy of 2 representative topical agents to prevent keloid recurrence after surgical excision. J Oral Maxillofac Surg. 2017;75:401.e401–6.

    Article  Google Scholar 

  47. Berman B, Harrison-Balestra C, Perez OA, Viera M, Villa A, Zell D, et al. Treatment of keloid scars post-shave excision with imiquimod 5% cream: a prospective, double-blind, placebo-controlled pilot study. J Drugs Dermatol. 2009;8:455–8.

    PubMed  Google Scholar 

  48. Cacao FM, Tanaka V, Messina MC. Failure of imiquimod 5% cream to prevent recurrence of surgically excised trunk keloids. Dermatol Surg. 2009;35:629–33.

    Article  CAS  PubMed  Google Scholar 

  49. Jalali M, Bayat A. Current use of steroids in management of abnormal raised skin scars. Surgeon. 2007;5:175–80.

    Article  CAS  PubMed  Google Scholar 

  50. Reish RG, Eriksson E. Scar treatments: preclinical and clinical studies. J Am Coll Surg. 2008;206:719–30.

    Article  PubMed  Google Scholar 

  51. Cruz NI, Korchin L. Inhibition of human keloid fibroblast growth by isotretinoin and triamcinolone acetonide in vitro. Ann Plast Surg. 1994;33:401–5.

    Article  CAS  PubMed  Google Scholar 

  52. Boyadjiev C, Popchristova E, Mazgalova J. Histomorphologic changes in keloids treated with Kenacort. J Trauma. 1995;38:299–302.

    Article  CAS  PubMed  Google Scholar 

  53. Poetschke J, Reinholz M, Schwaiger H, Epple A, Gauglitz GG. DLQI and POSAS scores in keloid patients. Facial Plast Surg. 2016;32:289–95.

    Article  CAS  PubMed  Google Scholar 

  54. Boutli-Kasapidou F, Tsakiri A, Anagnostou E, Mourellou O. Hypertrophic and keloidal scars: an approach to polytherapy. Int J Dermatol. 2005;44:324–7.

    Article  PubMed  Google Scholar 

  55. Robles DT, Berg D. Abnormal wound healing: keloids. Clin Dermatol. 2007;25:26–32.

    Article  PubMed  Google Scholar 

  56. Yosipovitch G, Widijanti Sugeng M, Goon A, Chan YH, Goh CL. A comparison of the combined effect of cryotherapy and corticosteroid injections versus corticosteroids and cryotherapy alone on keloids: a controlled study. J Dermatolog Treat. 2001;12:87–90.

    Article  CAS  PubMed  Google Scholar 

  57. Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg. 1999;25:224–32.

    Article  CAS  PubMed  Google Scholar 

  58. Apikian M, Goodman G. Intralesional 5-fluorouracil in the treatment of keloid scars. Australas J Dermatol. 2004;45:140–3.

    Article  PubMed  Google Scholar 

  59. Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004;30:54–6; discussion 56–57

    PubMed  Google Scholar 

  60. Wu XL, Liu W, Cao YL. [Clinical study on keloid treatment with intralesional injection of low concentration 5-fluorouracil]. Zhonghua Zheng Xing Wai Ke Za Zhi. 2006;22:44–6.

    Google Scholar 

  61. Wu XL, Gao Z, Song N, Liu W. [Clinical study of auricular keloid treatment with both surgical excision and intralesional injection of low-dose 5-fluorouracil and corticosteroids]. Zhonghua Yi Xue Za Zhi. 2009;89:1102–5.

    Google Scholar 

  62. Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006;32:907–15.

    CAS  PubMed  Google Scholar 

  63. Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or in combination with 5-fluorouracil for the treatment of keloid and hypertrophic scars. Clin Exp Dermatol. 2009;34:219–23.

    Article  CAS  PubMed  Google Scholar 

  64. Kafka M, Collins V, Kamolz LP, Rappl T, Branski LK, Wurzer P. Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: a systematic review. Wound Repair Regen. 2017;25:139–44.

    Article  PubMed  Google Scholar 

  65. Stewart N, Lim AC, Lowe PM, Goodman G. Lasers and laser-like devices: part one. Australas J Dermatol. 2013;54:173–83.

    Article  PubMed  Google Scholar 

  66. Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003;29:25–9.

    PubMed  Google Scholar 

  67. Dierickx C, Goldman MP, Fitzpatrick RE. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients. Plast Reconstr Surg. 1995;95:84–90; discussion 91–2

    Article  CAS  PubMed  Google Scholar 

  68. Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345:1198–200.

    Article  CAS  PubMed  Google Scholar 

  69. Allison KP, Kiernan MN, Waters RA, Clement RM. Pulsed dye laser treatment of burn scars. Alleviation or irritation? Burns. 2003;29:207–13.

    Article  CAS  PubMed  Google Scholar 

  70. Wittenberg GP, Fabian BG, Bogomilsky JL, Schultz LR, Rudner EJ, Chaffins ML, et al. Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment. Arch Dermatol. 1999;135:1049–55.

    Article  CAS  PubMed  Google Scholar 

  71. Akaishi S, Koike S, Dohi T, Kobe K, Hyakusoku H, Ogawa R. Nd:YAG laser treatment of keloids and hypertrophic scars. Eplasty. 2012;12:e1.

    PubMed  PubMed Central  Google Scholar 

  72. Cho SB, Lee JH, Lee SH, Lee SJ, Bang D, Oh SH. Efficacy and safety of 1064-nm Q-switched Nd:YAG laser with low fluence for keloids and hypertrophic scars. J Eur Acad Dermatol Venereol. 2010;24:1070–4.

    CAS  PubMed  Google Scholar 

  73. Al-Mohamady Ael S, Ibrahim SM, Muhammad MM. Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: a comparative randomized split-scar trial. J Cosmet Laser Ther. 2016;18:208–12.

    Article  Google Scholar 

  74. Rossi A, Lu R, Frey MK, Kubota T, Smith LA, Perez M. The use of the 300 microsecond 1064 nm Nd:YAG laser in the treatment of keloids. J Drugs Dermatol. 2013;12:1256–62.

    PubMed  Google Scholar 

  75. Sebaratnam DF, Lim AC, Lowe PM, Goodman GJ, Bekhor P, Richards S. Lasers and laser-like devices: part two. Australas J Dermatol. 2014;55:1–14.

    Article  PubMed  Google Scholar 

  76. Reinholz M, Schwaiger H, Heppt MV, Poetschke J, Tietze J, Epple A, et al. Comparison of two kinds of lasers in the treatment of acne scars. Facial Plast Surg. 2015;31:523–31.

    Article  CAS  PubMed  Google Scholar 

  77. Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426–38.

    Article  PubMed  Google Scholar 

  78. Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38:142–9.

    Article  PubMed  Google Scholar 

  79. Dams SD, de Liefde-van Beest M, Nuijs AM, Oomens CW, Baaijens FP. Pulsed heat shocks enhance procollagen type I and procollagen type III expression in human dermal fibroblasts. Skin Res Technol. 2010;16:354–64.

    Google Scholar 

  80. Helbig D, Paasch U. Molecular changes during skin aging and wound healing after fractional ablative photothermolysis. Skin Res Technol. 2011;17:119–28.

    Article  PubMed  Google Scholar 

  81. Uebelhoer NS, Ross EV, Shumaker PR. Ablative fractional resurfacing for the treatment of traumatic scars and contractures. Semin Cutan Med Surg. 2012;31:110–20.

    Article  CAS  PubMed  Google Scholar 

  82. El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA. Ablative CO fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol. 2015;14(4):324–31.

    Article  PubMed  Google Scholar 

  83. Nicoletti G, De Francesco F, Mele CM, Cataldo C, Grella R, Brongo S, et al. Clinical and histologic effects from CO2 laser treatment of keloids. Lasers Med Sci. 2013;28:957–64.

    Article  PubMed  Google Scholar 

  84. Orringer JS, Kang S, Johnson TM, Karimipour DJ, Hamilton T, Hammerberg C, et al. Connective tissue remodeling induced by carbon dioxide laser resurfacing of photodamaged human skin. Arch Dermatol. 2004;140:1326–32.

    PubMed  Google Scholar 

  85. Levi B, Ibrahim A, Mathews K, Wojcik B, Gomez J, Fagan S, et al. The use of CO2 fractional photothermolysis for the treatment of burn scars. J Burn Care Res. 2016;37:106–14.

    Article  PubMed  Google Scholar 

  86. Cervelli V, Gentile P, Spallone D, Nicoli F, Verardi S, Petrocelli M, et al. Ultrapulsed fractional CO2 laser for the treatment of post-traumatic and pathological scars. J Drugs Dermatol. 2010;9:1328–31.

    PubMed  Google Scholar 

  87. Ho D, Jagdeo J. Excellent aesthetic and functional outcome after fractionated carbon dioxide laser skin graft revision surgery: case report and review of laser skin graft revision techniques. J Drugs Dermatol. 2015;14:1285–8.

    CAS  PubMed  Google Scholar 

  88. Hultman CS, Edkins RE, Wu C, Calvert CT, Cairns BA. Prospective, before-after cohort study to assess the efficacy of laser therapy on hypertrophic burn scars. Ann Plast Surg. 2013;70:521–6.

    Article  CAS  PubMed  Google Scholar 

  89. Hultman CS, Friedstat JS, Edkins RE, Cairns BA, Meyer AA. Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up. Ann Surg. 2014;260:519–29; discussion 529–32

    PubMed  Google Scholar 

  90. Krakowski AC, Goldenberg A, Eichenfield LF, Murray JP, Shumaker PR. Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures. Pediatrics. 2014;134:e1700–5.

    Article  PubMed  Google Scholar 

  91. Kwan JM, Wyatt M, Uebelhoer NS, Pyo J, Shumaker PR. Functional improvement after ablative fractional laser treatment of a scar contracture. PM R. 2011;3:986–7.

    Article  PubMed  Google Scholar 

  92. van Drooge AM, Vrijman C, van der Veen W, Wolkerstorfer A. A randomized controlled pilot study on ablative fractional CO2 laser for consecutive patients presenting with various scar types. Dermatol Surg. 2015;41:371–7.

    Article  PubMed  CAS  Google Scholar 

  93. Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, et al. Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol. 2014;150:187–93.

    Article  PubMed  Google Scholar 

  94. Poetschke J, Dornseifer U, Clementoni MT, Reinholz M, Schwaiger H, Steckmeier S, et al. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach. Lasers Med Sci. 2017;32:1031–40.

    Article  PubMed  Google Scholar 

  95. Har-Shai Y, Amar M, Sabo E. Intralesional cryotherapy for enhancing the involution of hypertrophic scars and keloids. Plast Reconstr Surg. 2003;111:1841–52.

    Article  PubMed  Google Scholar 

  96. Har-Shai Y, Brown W, Labbe D, Dompmartin A, Goldine I, Gil T, et al. Intralesional cryosurgery for the treatment of hypertrophic scars and keloids following aesthetic surgery: the results of a prospective observational study. Int J Low Extrem Wounds. 2008;7:169–75.

    Article  PubMed  Google Scholar 

  97. Har-Shai Y, Sabo E, Rohde E, Hyams M, Assaf C, Zouboulis CC. Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies. Wound Repair Regen. 2006;14:18–27.

    Article  PubMed  Google Scholar 

  98. Mourad B, Elfar N, Elsheikh S. Spray versus intralesional cryotherapy for keloids. J Dermatolog Treat. 2016;27:264–9.

    Article  CAS  PubMed  Google Scholar 

  99. van Leeuwen MC, Bulstra AE, Ket JC, Ritt MJ, van Leeuwen PA, Niessen FB. Intralesional cryotherapy for the treatment of keloid scars: evaluating effectiveness. Plast Reconstr Surg Glob Open. 2015;3:e437.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Muir IF. On the nature of keloid and hypertrophic scars. Br J Plast Surg. 1990;43:61–9.

    Article  CAS  PubMed  Google Scholar 

  101. Leventhal D, Furr M, Reiter D. Treatment of keloids and hypertrophic scars: a meta-analysis and review of the literature. Arch Facial Plast Surg. 2006;8:362–8.

    Article  PubMed  Google Scholar 

  102. Zuber TJ, DeWitt DE. Earlobe keloids. Am Fam Physician. 1994;49:1835–41.

    CAS  PubMed  Google Scholar 

  103. Ragoowansi R, Cornes PG, Moss AL, Glees JP. Treatment of keloids by surgical excision and immediate postoperative single-fraction radiotherapy. Plast Reconstr Surg. 2003;111:1853–9.

    Article  PubMed  Google Scholar 

  104. Guix B, Henriquez I, Andres A, Finestres F, Tello JI, Martinez A. Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys. 2001;50:167–72.

    Article  CAS  PubMed  Google Scholar 

  105. Sallstrom KO, Larson O, Heden P, Eriksson G, Glas JE, Ringborg U. Treatment of keloids with surgical excision and postoperative X-ray radiation. Scand J Plast Reconstr Surg Hand Surg. 1989;23:211–5.

    CAS  PubMed  Google Scholar 

  106. van de Kar AL, Kreulen M, van Zuijlen PP, Oldenburger F. The results of surgical excision and adjuvant irradiation for therapy-resistant keloids: a prospective clinical outcome study. Plast Reconstr Surg. 2007;119:2248–54.

    Article  PubMed  CAS  Google Scholar 

  107. Mankowski P, Kanevsky J, Tomlinson J, Dyachenko A, Luc M. Optimizing radiotherapy for keloids: a meta-analysis systematic review comparing recurrence rates between different radiation modalities. Ann Plast Surg. 2017;78:403–11.

    Article  CAS  PubMed  Google Scholar 

  108. Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg. 2003;111:547–53; discussion 554–5

    PubMed  Google Scholar 

  109. Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001;27:23–7.

    CAS  PubMed  Google Scholar 

  110. Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg. 2006;32:1023–9; discussion 1029–30

    CAS  PubMed  Google Scholar 

  111. Saray Y, Gulec AT. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol. 2005;44:777–84.

    Article  PubMed  Google Scholar 

  112. Camacho-Martinez FM, Rey ER, Serrano FC, Wagner A. Results of a combination of bleomycin and triamcinolone acetonide in the treatment of keloids and hypertrophic scars. An Bras Dermatol. 2013;88:387–94.

    Article  PubMed  PubMed Central  Google Scholar 

  113. Jimenez SA, Freundlich B, Rosenbloom J. Selective inhibition of human diploid fibroblast collagen synthesis by interferons. J Clin Invest. 1984;74:1112–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Berman B, Duncan MR. Short-term keloid treatment in vivo with human interferon alfa-2b results in a selective and persistent normalization of keloidal fibroblast collagen, glycosaminoglycan, and collagenase production in vitro. J Am Acad Dermatol. 1989;21:694–702.

    Article  CAS  PubMed  Google Scholar 

  115. Tredget EE, Shankowsky HA, Pannu R, Nedelec B, Iwashina T, Ghahary A, et al. Transforming growth factor-beta in thermally injured patients with hypertrophic scars: effects of interferon alpha-2b. Plast Reconstr Surg. 1998;102:1317–28; discussion 1329–30

    Article  CAS  PubMed  Google Scholar 

  116. Young VL, Bush J, O’Kane S. A new approach for the prophylactic improvement of surgical scarring: avotermin (TGF beta 3). Clin Plast Surg. 2009;36:307–13, viii

    Article  PubMed  Google Scholar 

  117. Occleston NL, O’Kane S, Laverty HG, Cooper M, Fairlamb D, Mason T, et al. Discovery and development of avotermin (recombinant human transforming growth factor beta 3): a new class of prophylactic therapeutic for the improvement of scarring. Wound Repair Regen. 2011;19(Suppl 1):s38–48.

    Article  PubMed  Google Scholar 

  118. Ferguson MW, Duncan J, Bond J, Bush J, Durani P, So K, et al. Prophylactic administration of avotermin for improvement of skin scarring: three double-blind, placebo-controlled, phase I/II studies. Lancet. 2009;373:1264–74.

    Article  CAS  PubMed  Google Scholar 

  119. Samadikuchaksaraei A, Mehdipour A, Habibi Roudkenar M, Verdi J, Joghataei MT, As’adi K, et al. A dermal equivalent engineered with TGF-beta3 expressing bone marrow stromal cells and amniotic membrane: cosmetic healing of full-thickness skin wounds in rats. Artif Organs. 2016;40:E266–79.

    Article  CAS  PubMed  Google Scholar 

  120. Fang F, Huang RL, Zheng Y, Liu M, Huo R. Bone marrow derived mesenchymal stem cells inhibit the proliferative and profibrotic phenotype of hypertrophic scar fibroblasts and keloid fibroblasts through paracrine signaling. J Dermatol Sci. 2016;83:95–105.

    Article  CAS  PubMed  Google Scholar 

  121. Wu Y, Peng Y, Gao D, Feng C, Yuan X, Li H, et al. Mesenchymal stem cells suppress fibroblast proliferation and reduce skin fibrosis through a TGF-beta3-dependent activation. Int J Low Extrem Wounds. 2015;14:50–62.

    Article  CAS  PubMed  Google Scholar 

  122. Poetschke J, Schwaiger H, Gauglitz GG. Current and emerging options for documenting scars and evaluating therapeutic progress. Dermatol Surg. 2017;43(Suppl 1):S25–36.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gerd G. Gauglitz .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Gauglitz, G.G., Poetschke, J. (2020). Scarring and Scar Management. In: Jeschke, M., Kamolz, LP., Sjöberg, F., Wolf, S. (eds) Handbook of Burns Volume 1. Springer, Cham. https://doi.org/10.1007/978-3-030-18940-2_38

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-18940-2_38

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18939-6

  • Online ISBN: 978-3-030-18940-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics