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

Keloids (KSs) and hypertrophic scars (HSs) occur more frequently in populations with higher and mixed skin phototypes, such as those in Latin America. While lasers and other energy-based devices (EBDs) have broadened therapeutic options for scar management, their use in darker and genetically diverse populations presents specific challenges, especially concerning pigmentary complications and treatment safety.

This study aimed to develop a consensus among Latin American experts on the safe and effective use of lasers, EBDs and combination therapies for managing KSs/HSs.

A Delphi-based consensus process was conducted among 22 Latin American dermatologists specialized in scar management. The experts evaluated 23 representative clinical scenarios over three anonymous iterative rounds. They selected first- and second-line treatments from a predefined list of therapeutic options, which included lasers, injectables, dressings and adjunctive therapies. Consensus was defined in advance using established agreement thresholds.

Consensus was reached for nearly all (21 of 23) clinical scenarios. Early and inflammatory scars were primarily treated with vascular-targeting devices, silicone or hydrocolloid dressings and low-level light therapy. Actively growing KSs/HSs were primarily treated with intralesional corticosteroids combined with 5-fluorouracil or bleomycin, often integrated with vascular lasers or occlusive dressings. Fractional lasers were recommended primarily to improve texture after scar flattening, whereas pigment-targeting modalities were preferred to address residual dyschromia. Combination therapies were consistently preferred over monotherapies, and specific safety recommendations were established for individuals with higher skin phototypes.

This consensus provides population-adapted guidance for the multimodal management of scars in Latin American patients and may improve outcomes while minimizing adverse effects.