From the Guidelines
The best treatment for scars on the body is a combination of microneedling and platelet-rich plasma (PRP), which has been shown to be more effective than microneedling alone or other single methods. This treatment approach is supported by the most recent and highest quality study, which found that PRP combined with microneedling resulted in a significant improvement in atrophic acne scars, with an average improvement of 85.4% on the right side and 82.9% on the left side of the face 1.
For fresh scars, silicone sheets or gel (like Scaraway, Mederma Advanced, or Kelo-cote) applied daily for at least 12 hours per day over 2-3 months can significantly improve appearance. For older scars, a combination approach works best: daily sunscreen (SPF 30+) to prevent darkening, topical retinoids like tretinoin 0.025-0.1% applied nightly to promote collagen remodeling, and moisturizers containing ingredients like vitamin E, onion extract, or centella asiatica.
Some key points to consider when treating scars include:
- The effectiveness of treatments varies because scars result from individual healing responses, with factors like genetics, scar location, and wound care all influencing outcomes.
- Scars improve most within the first year, so early intervention is key.
- For raised scars (hypertrophic or keloid), pressure therapy or corticosteroid injections (triamcinolone 10-40 mg/ml every 4-6 weeks) may be necessary.
- Deep or extensive scars might require professional treatments like laser therapy, microneedling, or surgical revision.
- Patient satisfaction is higher with PRP combined with microneedling, with 43% of patients showing an excellent response and 36% of patients having more than 75% satisfaction 1.
Overall, the treatment of scars should be individualized based on the type and severity of the scar, as well as the patient's preferences and values. However, the combination of microneedling and PRP is a promising treatment approach that has been shown to be effective in improving the appearance of atrophic acne scars 1.
From the Research
Treatment Options for Scars
- Silicone sheeting or gel is considered the first-line prophylactic and treatment option for hypertrophic scars and keloids, as it has been demonstrated to be effective in many clinical studies 2, 3, 4.
- Other non-invasive options for scar treatment include:
- Pressure garments, which may be indicated for more widespread scarring, especially after burns 3, 4.
- Taping and hydration of the early scar tissue 3, 4.
- Ultraviolet (UV) protection of the early scar tissue 3, 4.
- Scar massage, which has been shown to have low to high efficacy in preventing or reducing scars 2.
- Invasive treatment options for scars include:
- Intralesional injections of corticosteroids, such as triamcinolone acetonide, which have been shown to be effective in treating hypertrophic scars and keloids 2, 5, 4.
- 5-fluorouracil, which has been shown to have high efficacy in treating existing hypertrophic scars 2.
- Cryotherapy, radiotherapy, and laser therapy, which may be used alone or as part of combination therapy 4.
- Surgical excision, which may be necessary for the correction of permanent unaesthetic scars 3, 4.
Medications for Scar Treatment
- Corticosteroids, such as triamcinolone acetonide, are commonly used to treat hypertrophic scars and keloids, and have been shown to be effective in reducing scar size and symptoms 2, 5, 4.
- 5-fluorouracil has been shown to have high efficacy in treating existing hypertrophic scars, and may be used in combination with other treatments 2.
- Bleomycin has been shown to have high efficacy in treating keloid scars, and may be used as an adjunct to excision 2.
- Mitomycin C and radiation therapy may also be used as adjuncts to excision for keloid scars 2.