Treatment of Hypertrophic Scars
Silicone gel sheeting applied for at least 4-12 hours daily is the first-line treatment for hypertrophic scars, with pulsed-dye laser (PDL) therapy reserved for vascular components or refractory cases. 1, 2
First-Line Treatment: Silicone-Based Products
- Silicone gel sheeting or ointment represents the gold standard, non-invasive first-line option for both prevention and treatment of hypertrophic scars 2
- Apply silicone sheets for at least 4 hours per day (though 12+ hours daily is optimal) to achieve significant improvement in scar color, thickness, and elasticity 3
- Treatment should begin as soon as an itchy red streak develops in the maturing wound 4
- Silicone therapy demonstrates 85% improvement rates across treated lesions, regardless of scar maturity 4
- This modality works without requiring positive pressure and is effective due to mechanisms independent of silica deposition 4
Second-Line Treatment: Laser Therapy
- Pulsed-dye laser (PDL) is recommended specifically for residual vascular components of hypertrophic scars, with complication rates under 1% 1
- Fractional non-ablative lasers serve as an alternative laser modality, comprising 24.5% of procedural therapies 1
- Critical caveat: Laser therapy carries significant risks of atrophic scarring and hypopigmentation, particularly in darker skin types 1
- Reserve laser treatment for scars that fail to respond adequately to silicone therapy or when prominent vascular components persist 1, 5
Additional Treatment Options
- Intralesional corticosteroid injections can be combined with silicone therapy for more aggressive scars 5, 2
- Pressure therapy, when feasible anatomically, provides adjunctive benefit 6, 2
- Topical treatments including onion extract, imiquimod 5% cream, and vitamin preparations have supporting evidence but are considered secondary options 6
- Cryotherapy and intralesional 5-fluorouracil represent invasive alternatives for refractory cases 5, 2
Monitoring Protocol
- Re-evaluate patients every 4-8 weeks using standardized assessment tools, photography, or body maps to document scar characteristics and track progression 1, 2
- Assess color, thickness, and elasticity objectively at each visit 3
- Continue treatment until maximum improvement plateaus, which typically requires 1-16 months depending on scar maturity 3
Prevention Strategies
- Avoid sun exposure to treated areas 2
- Apply compression therapy when anatomically appropriate 2
- Use moisturizers regularly 2
- Patients predisposed to excessive scarring should avoid nonessential surgery 5
Common Pitfalls
- Insufficient treatment duration: Many patients discontinue silicone therapy prematurely; emphasize that even mature scars (up to 62 years old) can improve with consistent application 3
- Premature laser use: Avoid laser therapy as first-line treatment due to risks of worsening scarring, especially in darker skin types 1
- Inadequate follow-up: Without regular 4-8 week assessments, opportunities to escalate therapy for non-responders are missed 2