What is the best treatment for scars in children?

Best Treatments for Scars in Children

Silicone-based products are the first-line treatment for scars in children, with topical silicone gel or sheets being the gold standard for both prevention and treatment of hypertrophic scars. 1, 2

Types of Scars and Initial Assessment

• Identify the type of scar:

  • Hypertrophic scars - raised, red, confined to wound boundaries
  • Keloid scars - extend beyond wound boundaries
  • Atrophic scars - depressed or indented
  • Striae distensae (stretch marks)

• Consider scar characteristics:

  • Location (face, joints, trunk)
  • Age of scar (new vs. mature)
  • Symptoms (pain, itching, tightness)
  • Impact on function and quality of life

First-Line Treatments

Silicone-Based Products

• Silicone gel sheets or ointment: Apply for 12-24 hours daily for at least 2-3 months 1
  • For children: Monitor skin for irritation, rash, or breakdown 3
  • May be less practical for younger children who might remove sheets

Moisturizers and Emollients

• Apply immediately after bathing to improve skin hydration
• Use at least twice daily
• For keratosis pilaris-like scarring:
  • Children >2 years: 10-20% urea-based products once daily 4
  • Children <2 years: Lower concentrations (5-10%) 4

Second-Line Treatments

For Hypertrophic Scars

• Massage therapy: Gentle massage of scar tissue may help flatten and soften scars 1
• Pressure garment therapy: For larger scars, especially after burns (low efficacy but commonly used) 1

For Keloid Scars

• Intralesional corticosteroids: For older children with keloid scars 2
  • Caution: Avoid in young children due to pain and potential side effects
  • Should be administered by dermatologists

Special Considerations for Children

1. Sensitive Areas:

   • Avoid keratolytics on face or flexural areas due to risk of irritation 4
   • Consider topical calcineurin inhibitors (tacrolimus 0.1%) for facial scars 4

2. Age-Specific Concerns:

   • Younger children: Use lower concentrations of active ingredients 4
   • Limit application of higher-concentration products (>10% urea) in children under 2 years 4

3. Prevention Strategies:

   • Tension reduction during wound healing 1
   • Wound edge eversion during closure 1
   • Sun protection of healing wounds and scars

Treatment Algorithm

1. New scars (0-6 months):

   • Begin with silicone gel/sheets as first-line therapy
   • Apply moisturizers twice daily
   • Ensure sun protection

2. Persistent scars (>6 months):

   • Continue silicone therapy
   • Consider adding gentle massage
   • For hypertrophic scars: Consider pressure therapy for larger areas

3. Severe or keloid scars:

   • Refer to pediatric dermatologist for consideration of intralesional therapy or other advanced treatments

Important Caveats

• Avoid onion extract products in children as evidence for efficacy is low 1, 5
• Avoid salicylic acid in children under 1 year 4
• Discontinue any product if significant irritation occurs 4
• Manage expectations - complete elimination of scars is not possible, but significant improvement can be achieved

Monitoring and Follow-up

• Re-evaluate every 4-8 weeks to assess response and adjust treatment 2
• Continue treatment for at least 3-6 months for optimal results
• Consider psychological impact of scarring, especially for visible scars

By following this evidence-based approach, most pediatric scars can be effectively managed with noninvasive treatments, with silicone-based products being the cornerstone of therapy.