Keloid and hypertrophic scars: a review of recent developments in pathogenesis and management

The treatment of keloid and hypertrophic scars remains a challenging clinical problem despite numerous proposed therapies reported in the literature. This is due to the fact that the mechanisms that bring about keloid/hypertrophic scars are not completely understood. This article reviews the pertinent literature regarding the pathophysiology and management of keloid and hypertrophic scars.

A computerized literature search using MEDLINE was conducted for published articles on keloid and hypertrophic scars. The medical subject headings "keloid" or "hypertrophic scar" were combined with "treatment" or "management" or "mechanisms" or "pathophysiology" using the Boolean operator "AND" to narrow the searches. A review of selected relevant literature was undertaken.

Numerous advances have been made in understanding the process of formation of wound healing and scar formation. This increased knowledge has led to the introduction of new treatments as well as to a better understanding of how older treatments work. These include surgical excision, intralesional steroid injection, cryotherapy, laser therapy, irradiation, mechanical compression dressing, silicone sheet applications, intralesional interferon injection, or combination of techniques. Many of the treatment modalities have a defined biologic basis while others are based on anecdotal reports.

Presently there is still no single, reliable and effective treatment protocol for keloid and hypertrophic scars. However, surgical excision followed by postoperative intralesional steroid injection seems to provide a reasonable treatment outcome with low recurrence rate.