From the Guidelines
Post-traumatic scar formation under the skin should be treated with caution, especially in individuals with a history of keloid formation, as the outcome is uncertain whenever there is trauma to the skin resulting in scar. Treatment options for post-traumatic scar formation under the skin include both non-surgical and surgical approaches.
- For mild to moderate scars, topical treatments such as silicone gel sheets or silicone-based creams can help flatten and soften scars.
- Pressure therapy using compression garments may be beneficial for larger areas.
- Corticosteroid injections can reduce inflammation and scar thickness.
- For more severe cases, surgical options include scar revision, excision, or subcision.
- Laser therapy, particularly fractional CO2 or pulsed-dye lasers, can improve scar appearance by stimulating collagen remodeling.
- Dermal fillers may help with depressed scars. According to 1, adolescents with a history of keloid formation should avoid body modifications that puncture the skin, as this can lead to uncertain outcomes. Additionally, 1 suggests that teenagers with a personal or family history of keloids should be cautioned about the risk associated with scarification and other body modification processes. Early intervention is crucial as scars respond better to treatment within the first 6-12 months of formation. These treatments work by modifying collagen production and arrangement, reducing inflammation, and promoting proper tissue remodeling during the healing process.
From the Research
Treatment Options for Post-Traumatic Scar Formation
- The treatment options for post-traumatic scar formation under the skin vary depending on the specific scar endotype, but fall under one of three main categories:
- Leave alone
- Non-invasive management
- Invasive management 2
- Non-invasive management of skin scarring remains the most accessible, as many formulations are over-the-counter, and include silicone-based, onion extract-based, and green tea-based treatments 2
- Invasive treatment options include intralesional injections with steroids, 5-FU, PDT, and laser with surgical scar excision as a last resort, especially in keloid scar management unless combined with an appropriate adjuvant therapy 2, 3
Current Research and Advances
- Current research targeting inflammatory mediators, the epithelial to mesenchymal transition, and regulators of myofibroblast differentiation shows promising results in reducing fibrosis and scarring 4
- A multimodal approach addressing all three phases of wound healing may provide the best therapeutic outcome 4
- Novel therapies involving the use of purified human cells as well as agents that target specific cells and modulate the immune response to injury are currently undergoing testing 5
Keloid Treatments
- Current literature supports silicone gel or sheeting with corticosteroid injections as first-line therapy for keloids 3
- Adjuvant intralesional 5-fluorouracil (5-FU), bleomycin, or verapamil can be considered, although mixed results have been reported with each 3
- Laser therapy can be used in combination with intralesional corticosteroids or topical steroids with occlusion to improve drug penetration 3
- Excision of keloids with immediate post-excision radiation therapy is an effective option for recalcitrant lesions 3