Update on the Treatment of Scars

June 2019 | Volume 18 | Issue 6 | Original Article | 550 | Copyright © June 2019

Noelani González MD,a David J. Goldberg MD JDb

aSkin Laser and Surgery Specialists of NY and NJ bSkin Laser and Surgery Specialists of NY and NJ; Icahn School of Medicine at Mount Sinai, New York, NY

Abstract
Background: Treatment of scars continues to be a persisting challenge. Scar classification is paramount in determining an appropriate treatment strategy. They can be classified into hypertrophic, keloid, or atrophic scars. With the increasing demand for 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.

Methods: A Pubmed search was performed for the most recent papers on scar treatments. Findings and applications are discussed in this review. Results: Studies evaluating the efficacy and safety of microneedling, filler agents, toxins, silicone gels, and laser devices such as ablative, non-ablative, fractional, SRT, and radiofrequency are discussed.

Conclusion: Review of the literature revealed a myriad of options for the treatment of different scar types. Although there is not vast evidence in the literature in regard to combination treatments, these are becoming more popular, and it is the author’s opinion that combination treatments yield better overall results.

J Drugs Dermatol. 2019;18(6):550-555.

INTRODUCTION

Treatment of scars remains a persisting challenge. Scarring can be classified as a fibrous tissue disorder, which can occur as a consequence of inflammatory or non-inflammatory processes.1 Abnormal scarring is a well-known complication of wound healing; moreover scars can cause cosmetic, functional, and even psychological impact. Scar classification is paramount in determining an appropriate treatment strategy. They can be classified into hypertrophic, keloid, or atrophic scars.2

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
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