Treatment Options for Non-Keloid Scars

Silicone gel sheeting is the first-line treatment for non-keloid scars due to its safety profile and effectiveness in improving scar appearance.

First-Line Treatments

Silicone gel sheets: Applied directly to the scar for 12-24 hours daily for at least 2-3 months 1, 2
Self-drying silicone gel: Alternative to sheets, particularly useful for visible or irregularly shaped areas 1
Benefits include improved scar texture, color, and thickness 3

Tretinoin cream: Effective for superficial scars with 30.3% reduction in appearance after 16 weeks of twice-daily use 4
Diclofenac gel (3% in 2.5% hyaluronic acid): Moderate efficacy with low morbidity for mild scars 4
5-Fluorouracil cream (5%): Effective at reducing superficial scars by approximately 70% when used twice daily for 3 weeks 4

Cryotherapy: Effective for up to 75% of lesions, particularly for thicker scars
- Application technique: Apply liquid nitrogen for 15-20 seconds until 1-2mm of surrounding skin appears frozen, thaw for 20-60 seconds, then repeat 4
- May cause hypopigmentation and should be avoided on eyelids, lips, nose, and ears 4
Photodynamic therapy (PDT): Effective in up to 91% of cases with consistently good cosmetic results 4
- Particularly suitable for superficial and confluent scars
- Requires dedicated light source and photosensitizing cream

Surgical excision: Appropriate for discrete scars when diagnostic uncertainty exists 4
Curettage: Useful for hyperkeratotic scars, may require multiple cycles 4
Phototherapeutic keratectomy (PTK): For superficial corneal scars, may be repeated but can result in postoperative haze 4

Cryotherapy with intralesional medications: Higher efficacy rates (89-91%) when combined 4
Cryotherapy with 5-FU: Reduces treatment duration and side effects while maintaining efficacy 4

Laser therapy: Carbon dioxide laser treatment shows promising results for resistant scars 4
Mitomycin-C: Used after superficial keratectomy to prevent scarring, particularly when ablation depth exceeds 50-75μm 4
- Caution: Off-label use with potential risks including keratocyte depletion

For superficial scars:
- Start with silicone gel sheeting or self-drying gel for 2-3 months
- If inadequate response, add topical treatments (tretinoin or 5-FU)
For deeper or resistant scars:
- Consider cryotherapy or PDT
- For discrete lesions, surgical excision may be appropriate
For specialized locations:
- Facial scars: Prefer silicone gel or PDT for better cosmetic outcomes
- Corneal scars: Consider PTK with possible adjunctive MMC

Regular follow-up is essential to monitor progress and adjust treatment as needed
Treatment duration typically ranges from 2-6 months for optimal results
Hyperpigmentation and hypopigmentation are common side effects, particularly with cryotherapy
Patients should be counseled about realistic expectations and potential side effects

Avoid cryotherapy on eyelids, lips, nose, and ears 4
Mitomycin-C requires careful dosing and application time to prevent complications 4
Secondary bacterial infection can occur with treatments that disrupt the epithelial layer; consider prophylactic topical antibiotics 4