The Role of Extracorporeal Shock Wave Therapy in Keloids and Hypertrophic Scars: A Systematic Review

Keloids and hypertrophic scars are pathological scars that result from a prolonged and aberrant response to wound healing, resulting in raised and thickened skin lesions. Traditional treatments include occlusive dressings, compression therapy, intralesional steroids, and surgical excision with refashioning. Extracorporeal shock wave therapy (ESWT) is a non-invasive treatment method that employs mechanotransduction to stimulate a biological cascade resulting in tissue regeneration. This review aims to explore the literature for published evidence on the role of ESWT in the treatment of keloids and hypertrophic scars. A literature search following the PRISMA guidelines was conducted on PUBMED, Google Scholar, and the Cochrane Database of Systematic Reviews, for studies demonstrating the use of ESWT in keloids and hypertrophic scars. From this, 79 articles were identified, 12 of which met the eligibility criteria and were thus analyzed and included in the study. As monotherapy for keloids, ESWT showed comparable improvements in functional and aesthetic outcomes compared to traditional intralesional steroid therapy. Keloids treated with combination therapy of ESWT with intralesional steroids had better outcomes than those treated with intralesional steroids alone. Improvements in hypertrophic scar cosmesis, discomfort, and function with the use of ESWT were reported. Histologic improvements such as decreased collagen content, reduction of fibrotic markers, and fibrogenic cytokines were also described. ESWT is a promising treatment modality for pathological scars, offering comparable outcomes to traditional therapies with added benefits such as non-invasiveness. Further research is warranted to establish optimal protocols and its role in pathological scar management.