Are there effective treatments for hypertrophic scars and keloids?

Various traditional and novel modalities for therapy exist. In general, hypertrophic scars respond well to less aggressive therapy, such as potent topical steroids, intralesional steroids, chronic pressure dressings, and even chronic occlusive dressings with medical Silastic gel sheeting. Some cases may require surgical revision or dermabrasion.

Keloids demand more aggressive therapy with long-term precautions to prevent recurrence. Surgical excision, corticosteroid injection, and cryotherapy alone can be used but are often not effective. A recent study has suggested that incomplete excision of keloids is associated with an increase chance of recurrence. Radiation has been employed with good results but should be used with caution and only by an experienced physician. Laser excision has theoretical advantages, but long-term studies have not demonstrated an advantage over conventional surgery. Combination approaches appear to work best. Cryosurgery followed by corticosteroid injection is effective in some patients. Surgical excision with subsequent steroid injection is probably the most effective approach. One regimen calls for steroid injection to the surgical site 1 to 4 weeks postoperatively and then monthly for 6 months.

Tan K, Shah N, Pritchard SA, et al: The influence of surgical excision margins on keloid prognosis, Ann Plast Surg 64:55–58, 2010.