What prescription medications are effective for treating scarring?

Prescription Medications for Scarring

Intralesional triamcinolone acetonide (TAC) is the most effective first-line prescription medication for treating hypertrophic scars and keloids. 1 This corticosteroid injection works by reducing inflammation, decreasing fibroblast proliferation, and inhibiting collagen synthesis in abnormal scar tissue.

Types of Scars and Their Management

Different types of scars require different treatment approaches:

Hypertrophic Scars and Keloids

1. First-line therapy: Intralesional triamcinolone acetonide (TAC)

   • Concentration: 10-40 mg/ml depending on scar size and location
   • Frequency: Every 2-4 weeks until desired response
   • Mechanism: Anti-inflammatory, antiproliferative, and vasoconstrictive effects 2
   • Common combination: Often combined with cryotherapy for enhanced efficacy 3

2. Second-line options:

   • TAC + 5-Fluorouracil (5-FU): Superior to TAC alone for medium and long-term treatment 1
   • TAC + Verapamil: Effective with stable long-term results 4
   • Botulinum toxin A: Shows better improvement in pliability compared to TAC alone 1

3. Cautions with TAC:

   • Higher risk of skin atrophy and telangiectasia at concentrations of 20-40 mg/ml 1
   • Avoid in patients with active skin infections

Corneal Scarring

For corneal opacification and scarring, topical corticosteroids are commonly used to reduce inflammation, though their role in limiting corneal scar tissue development after acute processes has not been well established 5.

Other agents that have been used to reduce scarring following corneal procedures include:

• Mitomycin-C (MMC)
• 5-Fluorouracil
• Tacrolimus
• Octreotide
• Pirfenidone

However, these agents have been associated with epithelial surface toxicity at commonly used doses or have not been thoroughly evaluated for their anti-scarring effects in corneal disease 5.

Atrophic Scars

For atrophic scars (such as acne scarring):

• Topical retinoids (adapalene, tretinoin) can help with mild atrophic scarring 6
• For more severe cases, procedural interventions rather than topical medications are typically more effective

Evidence-Based Approach to Scar Management

For Prevention of Hypertrophic Scars:

1. Silicone-based products (sheets or gel)
2. Tension reduction techniques
3. Wound edge eversion during closure

For Treatment of Existing Hypertrophic Scars:

1. Intralesional TAC injections
2. Laser therapy (pulsed-dye or CO2)
3. Intralesional 5-FU or combination therapy (TAC+5-FU)
4. Bleomycin injections for resistant cases

For Keloid Scars:

Effective adjuncts to surgical excision include:

1. Intralesional corticosteroids (TAC)
2. Mitomycin C
3. Bleomycin
4. Radiation therapy 7

Practical Considerations

• Dosing for TAC: Applied as a thin film 2-3 times daily for topical formulations; for intralesional injections, dosage depends on scar size and location 2
• Duration of treatment: Multiple sessions are typically required, with reassessment after 3-4 treatments
• Combination therapy: Often more effective than monotherapy, particularly TAC+5-FU for resistant scars 1, 4
• Monitoring: Watch for adverse effects including skin atrophy, telangiectasia, and hypopigmentation with TAC

Common Pitfalls to Avoid

1. Overtreatment: Excessive concentration or frequency of TAC can lead to skin atrophy and telangiectasia
2. Monotherapy expectation: Single modality treatment is often insufficient for significant scars
3. Delayed intervention: Early treatment of hypertrophic scars and keloids yields better results
4. Inadequate follow-up: Regular monitoring is essential to assess response and adjust treatment
5. Unrealistic expectations: Complete resolution of scars is often not achievable; the goal is improvement

For optimal outcomes, treatment should begin early in the scar formation process, and combination therapies should be considered for resistant cases. The most recent evidence suggests that while TAC remains the first-line prescription treatment for hypertrophic and keloid scars, combination approaches with 5-FU or verapamil may provide superior long-term results with fewer side effects 1, 4.