A scoping review of the treatment of hypertrophic scars and keloids

Abstract

Hypertrophic scars and keloids are both conditions that represent an abnormal healing response by skin in response to some form of trauma. They are a cause of significant morbidity and psychological distress to patients. The costs associated with treating these conditions are considerable and had already reached 12 billion US dollars per annum by 2009. The lack of a well‐established treatment to reliably and effectively treat these conditions is demonstrated by the multitude of different treatments available. This scoping review aimed to review the treatment landscape available for hypertrophic scars and keloids to provide an overview of this varied field. A total of 113 studies representing 5211 participants were located. We identified over 40 different treatments utilised in the treatment of established scars and prophylactically to prevent scarring of wounds and burns. The heterogeneity of study design in terms of control arms, comparators, and outcome measures means that direct comparison of studies across the identified studies is difficult. While a large number of interventions were shown to have a beneficial effect compared with no treatment, there was no clear treatment that was both sufficiently effective and useable to have achieved widespread usage. This study highlights the wide variety of treatments available for hypertrophic scars and keloids. Future work will concentrate on more specific questions which will lend themselves to more detailed investigation using techniques such as network meta‐analysis. Future studies of treatments for hypertrophic scars and keloids should also ensure they are designed to allow for easy comparison with other studies.