Treatments of Hypertrophic Scars
Treatments include non-invasive methods such as compression garments, lasers, and silicone gel, or invasive methods such as surgery and intralesional injections (e.g.Triamincinolone). Intralesional injections have been estimated in a research study published in the British Journal of Plastic Surgery and covered by “opting health” to have up to a 72% improvement of symptoms and complete regression of the scar in 64% of patients.
Combinations of treatments are often used to improve treatment success. A study conducted in Hong Kong showed that a combination of compression garments and silicone gel improved the scars symptoms and scar thickness. Leventhal and colleagues from the Thomas Jefferson University Hospital in Philadelphia reviewed the scientific literature on the success of treatments for pathological scarring (keloids and hypertrophic scarring) and found that though improvement was seen in 60% of cases, treatment fell short of a cure.
Side Effects of Scar Treatments
Side effects can occur in both invasive and noninvasive treatments. A number of treatments, such as intralesional injections, and lasers can result in abnormal coloration of the scar. Allergies can occur from the dressings and antibiotics used after laser treatment and silicone gel can result in skin rashes.
Other side effects include wound breakdown (silicone gel), ulceration (intralesional injections of anti-mitotic drugs such as 5 fluorouracil), atrophy of underlying tissue (intralesional steroids) and pain (intralesional injections). Areas treated by lasers need to be protected from sun exposure. Surgery carries potential risks and side effects from both the procedure and the anesthesia.
Reducing Hypertrophic Scarring
Causes of hypertrophic scars are thought to be caused by prolonged inflammation or delayed wound healing; therefore, a well-balanced diet and stopping smoking will help improve wound healing. Prior to elective surgery, any family history or previous poor scarring should be discussed with the surgeon, but all operations and injuries will result in some form of scar tissue.
Morien and colleagues from the Florida School of Massage suggest that massaging the scar may improve range of motion in burn scars in children. Massage with oils such as vitamin E can improve the scars pliability and may also help with itching.
Future Treatments for Hypertrophic Scarring
There is no single treatment which is effective in all patients, and prevention remains better than cure. A number of new therapies are being assessed for the treatment or even prevention of hypertrophic scars.
These new treatments alter growth factors, or inflammation (e.g. tacrolimus), which are thought to cause overactive healing. Other therapies prevent the over production of collagen (e.g. verapamil) or modify the cells metabolism (retinoic acid). Scientists are also studying the use of a number of plant extracts, which appear to have a beneficial effect in both treating and preventing hypertrophic scarring.