From the Guidelines
To minimize scarring, it is crucial to choose a treatment option that balances efficacy with the potential for scarring, and based on the most recent evidence, photodynamic therapy stands out as a preferable option due to its effectiveness and consistently good cosmetic results. When considering treatments for conditions like actinic keratoses, the goal is not only to address the condition effectively but also to minimize the risk of scarring, which can impact the patient's quality of life.
Treatment Options for Scare Reduction
- Photodynamic therapy is effective in up to 91% of AKs in trials comparing it with cryotherapy, with consistently good cosmetic results 1.
- Cryosurgery, while effective for up to 75% of lesions, may leave scars, particularly for thicker lesions 1.
- The choice between these treatments should consider the lesion's characteristics, such as thickness and location, as well as the patient's skin type and potential for scarring.
Considerations for Minimizing Scars
- Early intervention is key, as scars are more responsive to treatment during the active remodeling phase, which can last up to 18 months after injury.
- Topical treatments, such as silicone-based products, and medical interventions like steroid injections or laser therapy, can be effective in managing scars but should be considered based on the individual case and the potential benefits versus risks.
Recent Evidence and Recommendations
- The most recent and highest quality study on the management of actinic keratoses suggests that photodynamic therapy offers a favorable balance between efficacy and cosmetic outcome 1.
- Other studies, while not directly related to scare reduction in the context of actinic keratoses, highlight the importance of careful consideration of treatment options to minimize scarring and promote optimal healing outcomes 1.
From the Research
Scar Reduction Methods
There are several methods that can be used to reduce scars, including:
- Silicone gel sheeting: This is a commonly used treatment for hypertrophic scars, and has been shown to be effective in reducing scar severity 2
- Pulsed dye laser (PDL): This is a type of laser therapy that has been shown to be effective in reducing hypertrophic and keloid scar severity 3, 4
- Intralesional triamcinolone: This is a type of steroid injection that can be used to reduce scar severity 3, 5
- Dermabrasion: This is a type of surgical procedure that can be used to reduce scar severity 3
- Topical agents: There are a variety of topical agents that can be used to reduce scar severity, including silicone gel, onion extract, and polyurethane 6, 2
Effectiveness of Scar Reduction Methods
The effectiveness of these methods can vary depending on the individual and the type of scar. For example:
- Silicone gel sheeting has been shown to be effective in reducing hypertrophic scar severity, but the evidence is limited and of low certainty 2
- PDL has been shown to be effective in reducing hypertrophic and keloid scar severity, but the evidence is limited and of low certainty 4
- Intralesional triamcinolone has been shown to be effective in reducing scar severity, but the evidence is limited and of low certainty 3, 5
- Dermabrasion has been shown to be effective in reducing scar severity, but the evidence is limited and of low certainty 3
Comparison of Scar Reduction Methods
There is limited evidence available to compare the effectiveness of different scar reduction methods. For example:
- A study comparing silicone gel sheeting to no treatment found that silicone gel sheeting may reduce scar severity, but the evidence is of low certainty 2
- A study comparing PDL to no treatment found that PDL may reduce hypertrophic and keloid scar severity, but the evidence is of low certainty 4
- A study comparing intralesional triamcinolone to no treatment found that intralesional triamcinolone may reduce scar severity, but the evidence is of low certainty 3, 5