Hypertrophic scars are characterized by their indurated and at times erythematous appearance, which is caused by the overgrowth of capillary vessels secondary to chronic inflammation.3 They typically develop secondary to trauma; burn injury, or insect bites. Traditionally, depending on the type and severity of the hypertrophic scar at hand, intralesional corticosteroids, silicone gel sheeting, or intralesional fluorouracil (5-FU) were being used. However, in the past decades, lasers have taken a front seat in the treatment of these types of scars and have aided in the delivery of the aforementioned medications.
Atrophic scars usually develop after an inflammatory process and can be the result of collagen loss and dermal atrophy. These tend to develop after insults to the skin such as acne, varicella, or trauma.4 These can cause an indentation or depression in the skin. Given that acne is such a common pre-existant concurrent disorder, it constitutes the vast majority of atrophic scars. In the case of atrophic scars, ablative lasers, chemical peels, and subcision were paramount in the past in treating these troublesome scars. Procedures such as ablative resurfacing have posed a challenge as such an approach might not be used in all skin types, and potentially could have a trying side effect profile. Less invasive treatments used posed difficulty in achieving the type of results sought after by the provider and/or patient.
With the increasing demands of patients to have less invasive procedures that result in equal or greater outcomes, there has been an increase in the variety of procedures for the management of scarring. Multiple studies have led to multiple treatment strategies for the improvement of the different types of scars. Patient evaluation and expectations should be done and discussed prior to the initiation of any treatment. Treatment combinations are typically the best option for patients. The recent development of non-ablative lasers, radiofrequency devices, and different uses of fillers and toxins amongst others have broadened the scope with which we can treat scars. This article will review the most current treatment strategies used to treat hypertrophic, keloidal, and atrophic scarring.
Microneedling (MN) is a relatively new treatment option. As the demand for less invasive but efficacious procedures is growing, MN fits in this category. This modality has been studied extensively recently, and more studies have been performed on