Consensus on energy-based devices for keloids and hypertrophic scars: A Latin American Delphi study

Area of Science:

• Dermatology and Aesthetic Medicine
• Scar Management and Regenerative Medicine
• Laser and Energy-Based Device Applications

Background:

• Keloids (KSs) and hypertrophic scars (HSs) are more prevalent in Latin American populations with higher and mixed skin phototypes.
• Lasers and energy-based devices (EBDs) offer advanced scar treatment options but pose challenges in darker skin tones due to risks of pigmentary complications and safety concerns.

Purpose of the Study:

• To establish a consensus among Latin American dermatologists on the safe and effective application of lasers, EBDs, and combination therapies for KSs/HSs.
• To provide tailored treatment guidelines for scar management specific to the diverse patient population in Latin America.

Main Methods:

• A Delphi-based consensus process involving 22 Latin American dermatologists specializing in scar management.
• Three anonymous iterative rounds where experts evaluated 23 clinical scenarios and selected first- and second-line treatments.
• Consensus was achieved based on predefined agreement thresholds for treatment recommendations.

Main Results:

• Consensus was reached for 21 out of 23 clinical scenarios, outlining preferred treatments for various scar types and stages.
• Early/inflammatory scars were managed with vascular-targeting devices, dressings, and low-level light therapy.
• Actively growing KSs/HSs were treated with intralesional corticosteroids combined with chemotherapy agents, often alongside vascular lasers or dressings.
• Fractional lasers were recommended for texture improvement post-flattening, and pigment-targeting modalities for dyschromia.
• Combination therapies were favored over monotherapies, with specific safety guidelines for higher skin phototypes.

Conclusions:

• The developed consensus offers population-adapted, multimodal guidance for managing scars in Latin American patients.
• Implementation of these guidelines is expected to enhance treatment outcomes and minimize adverse effects.
• This expert consensus addresses the unique needs of managing keloids and hypertrophic scars in diverse skin phototypes within the region.