What are the options to treat scars?

Effective Treatment Options for Scars

The most effective treatment for scars is a combination of microneedling with platelet-rich fibrin (PRF) or platelet-rich plasma (PRP), which shows significantly better outcomes than microneedling alone for improving scar appearance and patient satisfaction. 1

Types of Scars and First-Line Treatments

• Atrophic scars (depressed scars common after acne):

  • Microneedling combined with PRP or PRF is the first-line treatment, showing 70-85% improvement in appearance 1, 2
  • PRF appears more effective than PRP when combined with microneedling 1, 2
  • Protocol: 3-4 treatments, 1 month apart, with maintenance every 6 months 1

• Hypertrophic scars (raised scars within original wound boundaries):

  • Silicone-based products (sheets and gels) are the gold standard first-line treatment 3, 4
  • Intralesional corticosteroids for resistant cases 3, 4
  • Pulsed-dye laser and CO2 laser show high efficacy 3

• Keloid scars (raised scars extending beyond wound boundaries):

  • Combination approach: surgical excision plus adjunctive therapy 3
  • Effective adjuncts include corticosteroids, bleomycin, and radiation therapy 3

Advanced Treatment Options

Microneedling-Based Approaches

• Microneedling with PRP/PRF protocol:
  • Needle depth: 1.5mm (adjustable based on scar depth) 2
  • Frequency: 3-4 sessions at monthly intervals 1, 2
  • Application method: PRP/PRF should be applied before microneedling for optimal results 1
  • Patient satisfaction is significantly higher with combination therapy (36% reporting >75% improvement) versus microneedling alone (3% reporting >75% improvement) 1

Laser Treatments

• CO2 laser therapy:
  • Highly effective for hypertrophic scars 3
  • Can be combined with PRP for shorter downtime and faster healing 2
  • Wait 3 months post-surgery before initiating laser treatments 2

Other Effective Options

• Intralesional injections:

  • Corticosteroids: High efficacy for hypertrophic and keloid scars 3, 4
  • 5-fluorouracil: Effective for resistant hypertrophic scars 3
  • Bleomycin: Effective for keloids 3

• Topical treatments:

  • Silicone gel sheeting: Reduces scar height, erythema, and associated symptoms 5, 4
  • Onion extract: Low efficacy but may provide some benefit 5, 6
  • Pressure therapy: Low efficacy but may help with certain hypertrophic scars 3

Treatment Algorithm

1. Assessment phase:

   • Identify scar type (atrophic, hypertrophic, keloid)
   • Evaluate scar maturity (immature scars respond better to treatment) 2

2. For atrophic scars (e.g., acne scars):

   • First-line: Microneedling + PRF/PRP (3-4 monthly sessions) 1
   • Alternative: CO2 laser if microneedling is contraindicated 3

3. For hypertrophic scars:

   • First-line: Silicone-based products 3, 4
   • Second-line: Intralesional corticosteroids or pulsed-dye laser 3
   • Resistant cases: Consider 5-fluorouracil or combination therapy 3

4. For keloid scars:

   • Surgical excision followed by adjunctive therapy (corticosteroids, radiation) 3
   • Avoid surgery alone due to high recurrence rates 3

Important Considerations

• Wait at least 4-6 weeks after suture removal before initiating any laser or microneedling treatments 2
• Ideally, wait 3 months post-surgery before starting treatments to allow for initial scar maturation 2
• Begin with lower energy settings for the first treatment session to assess skin response 2
• Treatments should be spaced at least one month apart to allow for proper healing between sessions 2
• Combining treatments with autologous platelet concentrates enhances outcomes and reduces downtime 1, 2

Pitfalls to Avoid

• Applying PRP after microneedling rather than before may reduce efficacy 1
• Starting treatments too early after surgery can worsen scarring 2
• Using single modality treatments when combination approaches show superior results 1
• Failing to maintain consistent intervals between treatment sessions 1, 2
• Not providing maintenance treatments (recommended every 6 months) 1