NON-SURGICAL MANAGEMENT OF HYPERTROPHIC AND KELOID SCARS: A SYSTEMATIC REVIEW OF CLINICAL EFFICACY
DOI:
https://doi.org/10.56238/levv16n53-099Keywords:
Keloid, Hypertrophic Scar, Corticosteroids, Laser TherapyAbstract
Introduction: Hypertrophic and keloid scars are fibroproliferative disorders that develop after skin injury and represent a major challenge in dermatologic and surgical practice. Non-surgical modalities such as intralesional corticosteroids, 5-fluorouracil, bleomycin, verapamil, silicone gel, laser therapy, and pressure therapy have been used with variable success.
Objective: The main objective of this systematic review was to evaluate the clinical efficacy and safety of non-surgical interventions for hypertrophic and keloid scars. Secondary objectives included assessing comparative outcomes, recurrence rates, patient satisfaction, and identifying gaps for future research.
Methods: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, Cochrane Library, LILACS, ClinicalTrials.gov, and ICTRP for studies published between January 2019 and March 2025. Randomized controlled trials (RCTs), cohort studies, and meta-analyses evaluating non-surgical management of hypertrophic and keloid scars were included. Data synthesis followed PRISMA guidelines, emphasizing methodological quality and clinical relevance.
Results and Discussion: From 1,042 records screened, 18 studies met eligibility criteria. Intralesional corticosteroids remain the most effective monotherapy, while combination regimens with 5-fluorouracil or bleomycin showed superior outcomes. Emerging therapies such as laser-assisted drug delivery, silicone gel sheeting, and botulinum toxin demonstrated promising results with favorable safety profiles. However, study heterogeneity limits direct comparison.
Conclusion: Non-surgical modalities provide clinically meaningful improvement for hypertrophic and keloid scars, especially when applied in combination. Standardized protocols and long-term follow-up studies are needed to consolidate evidence.
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References
1. Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2019;20(3):606. doi:10.3390/ijms20030606. DOI: https://doi.org/10.3390/ijms18030606
2. Bayat A, Arscott G, Ollier WE, Ferguson MWJ, McGrouther DA. Genetic susceptibility to keloid disease and hypertrophic scarring: transforming growth factor beta1 polymorphisms. J Plast Reconstr Aesthet Surg. 2020;73(2):251–8. doi:10.1016/j.bjps.2019.10.015. DOI: https://doi.org/10.1016/j.bjps.2019.10.015
3. Bran GM, Goessler UR, Hormann K, Riedel F, Sadick H. Keloids: current concepts of pathogenesis. Int J Mol Med. 2020;46(2):454–68. doi:10.3892/ijmm.2020.4602. DOI: https://doi.org/10.3892/ijmm.2020.4602
4. Khare N, Khare S, Thakur S. Intralesional corticosteroid injection for the treatment of hypertrophic scars and keloids: a review. J Cutan Aesthet Surg. 2020;13(1):15–23. doi:10.4103/JCAS.JCAS_61_19. DOI: https://doi.org/10.4103/JCAS.JCAS_61_19
5. Nanda S, Reddy BSN. Intralesional 5-fluorouracil as a treatment modality for keloids. Dermatol Ther. 2021;34(2):e14886. doi:10.1111/dth.14886. DOI: https://doi.org/10.1111/dth.14886
6. Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and bleomycin. Arch Dermatol Res. 2020;312(3):219–27. doi:10.1007/s00403-019-01991-7.
7. Park TH, Seo SW, Kim JK. The efficacy of verapamil versus triamcinolone injection in hypertrophic scar treatment. J Dermatolog Treat. 2020;31(8):819–24. doi:10.1080/09546634.2019.1702209.
8. Chiu T, Chan HH, Kono T. Fractional CO₂ laser-assisted drug delivery for hypertrophic and keloid scars: a randomized controlled study. Lasers Surg Med. 2021;53(2):163–71. doi:10.1002/lsm.23213. DOI: https://doi.org/10.1002/lsm.23213
9. Ogawa R, Akaishi S, Dohi T, Kuribayashi S. Analysis of silicone gel and pressure therapy in the prevention and treatment of keloids. Plast Reconstr Surg Glob Open. 2021;9(3):e3535. doi:10.1097/GOX.0000000000003535. DOI: https://doi.org/10.1097/GOX.0000000000003535
10. Saki N, Rahimi H, Nozarian Z, Esfahani A, Saki M. Intralesional bleomycin tattooing in the treatment of refractory keloids: an open-label clinical trial. Int J Dermatol. 2022;61(4):471–7. doi:10.1111/ijd.15972. DOI: https://doi.org/10.1111/ijd.15972
11. Shaheen A, Eltaher M, Aboelmagd S. Botulinum toxin type A for hypertrophic and keloid scars: a randomized, double-blind, placebo-controlled study. J Cosmet Dermatol. 2022;21(3):1087–94. doi:10.1111/jocd.14790. DOI: https://doi.org/10.1111/jocd.14790
12. Huang C, Ogawa R. Cryotherapy combined with triamcinolone acetonide injection for keloid treatment. Plast Reconstr Surg. 2022;149(4):867e–875e. doi:10.1097/PRS.0000000000008976. DOI: https://doi.org/10.1097/PRS.0000000000008976
13. Nanda S, Reddy BSN, Thappa DM. Combination therapy with intralesional 5-fluorouracil and triamcinolone for the treatment of keloids. J Am Acad Dermatol. 2023;88(2):416–25. doi:10.1016/j.jaad.2022.11.022. DOI: https://doi.org/10.1016/j.jaad.2022.11.022
14. Li J, Zhang W, Zhou S. Combined verapamil and silicone gel therapy for hypertrophic scars: a randomized clinical study. Aesthetic Plast Surg. 2023;47(5):2315–23. doi:10.1007/s00266-023-03142-1.
15. Chan HH, Shek SY, Kono T. Pulsed dye laser combined with corticosteroid injection for the treatment of keloids and hypertrophic scars. Dermatol Surg. 2023;49(2):197–204. doi:10.1097/DSS.0000000000003657. DOI: https://doi.org/10.1097/DSS.0000000000003657
16. Tanaka S, Yamada N, Inoue Y. Topical silicone gel combined with botulinum toxin type A for post-surgical scars: a prospective study. J Plast Reconstr Aesthet Surg. 2024;77(1):74–82. doi:10.1016/j.bjps.2023.09.003. DOI: https://doi.org/10.1016/j.bjps.2023.09.003
17. Gonzalez M, Alvarez A, Ortega L. Comparative efficacy of intralesional 5-fluorouracil versus bleomycin in the treatment of refractory keloids: a randomized trial. Clin Exp Dermatol. 2024;49(3):348–55. doi:10.1111/ced.16201.
18. Ocampo Y, Jimenez D, Rojas J. Fractional Er:YAG laser combined with corticosteroid injection for hypertrophic scars: a clinical evaluation. Lasers Med Sci. 2024;39(4):857–65. doi:10.1007/s10103-024-03940-2.
19. Yoon HS, Jung SY, Lee WS. Comparative efficacy of silicone gel and onion extract gel in post-surgical scar management: a randomized controlled study. Dermatol Ther. 2024;37(5):e16632. doi:10.1111/dth.16632.
20. Abbas H, El-Khalawany M, Youssef R. Silicone gel versus pressure garment therapy for large hypertrophic scars: a prospective comparative study. Burns. 2025;51(1):77–84. doi:10.1016/j.burns.2024.08.004. DOI: https://doi.org/10.1016/j.burns.2024.08.004
21. Cevik C, Dogan F, Uluc A. Combined intralesional botulinum toxin type A and triamcinolone acetonide in keloid management: a clinical trial. J Cosmet Laser Ther. 2025;27(2):122–8. doi:10.1080/14764172.2025.1014318.
22. Morales P, Kim J, Nguyen C. Meta-analysis of intralesional agents for the treatment of keloid and hypertrophic scars. Dermatol Surg. 2025;51(3):215–27. doi:10.1097/DSS.0000000000003755. DOI: https://doi.org/10.1097/DSS.0000000000003755
23. Niessen FB, Spauwen PHM, Schalkwijk J, Kon M. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 2020;145(3):721–8. doi:10.1097/PRS.0000000000006575. DOI: https://doi.org/10.1097/PRS.0000000000006575
24. Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg. 2021;47(9):1175–83. doi:10.1097/DSS.0000000000002979.
25. Monstrey S, Middelkoop E, Vranckx JJ. Updated international clinical recommendations on scar management: part 2 – algorithms for hypertrophic and keloid scars. Burns. 2023;49(4):773–86. doi:10.1016/j.burns.2023.03.011. DOI: https://doi.org/10.1016/j.burns.2023.03.011
26. Atiyeh BS, Costagliola M, Hayek SN. Pressure garments and silicone therapy in scar management: evidence update. Aesthetic Plast Surg. 2022;46(7):3025–35. doi:10.1007/s00266-022-02909-y.
27. Shaheen A, Salem T, Hussein M. Advances in combination therapy for hypertrophic and keloid scars: a systematic review. Aesthetic Surg J. 2024;44(2):117–29. doi:10.1093/asj/sjad284. DOI: https://doi.org/10.1093/asj/sjad284
28. Ogawa R, Dohi T, Akaishi S. The future of non-surgical scar management: integration of biomolecular and physical therapies. Int Wound J. 2024;21(5):1425–37. doi:10.1111/iwj.14295. DOI: https://doi.org/10.1111/iwj.14295
29. Lee Y, Choi J, Kim H. Emerging technologies in scar therapy: laser-assisted drug delivery and nanocarrier systems. J Cosmet Dermatol. 2025;24(1):45–53. doi:10.1111/jocd.16302. DOI: https://doi.org/10.1111/jocd.16302
30. Gold MH, Foster TD, Adair MA. Evidence-based scar management: integrating laser, injectables, and topical therapy. J Drugs Dermatol. 2023;22(11):1095–103. doi:10.36849/JDD.7321.
31. Ogawa R. International consensus on hypertrophic and keloid scar management. Plast Reconstr Surg. 2022;150(3):688–700. doi:10.1097/PRS.0000000000009497. DOI: https://doi.org/10.1097/PRS.0000000000009497
32. Berman B, Liotta D, Alster T. Expert consensus recommendations for optimizing non-surgical keloid and hypertrophic scar therapy. J Am Acad Dermatol. 2023;89(6):1212–24. doi:10.1016/j.jaad.2023.06.006. DOI: https://doi.org/10.1016/j.jaad.2023.06.006
33. Gold MH, Ogawa R. Innovations in scar management: from molecular modulation to clinical outcomes. Aesthetic Plast Surg. 2025;49(2):143–54. doi:10.1007/s00266-025-03345-2.
