Current therapeutic strategies and available research models for investigating hypertrophic scars

Abnormal scarring, such as hypertrophic and keloid scars, are a result of pathological skin wound healing, and can reduce quality of life through psychological factors, persistent pain, and reduced mobility. Under physiological conditions, wounds proceed sequentially through the hemostatic, inflammatory, proliferative, and remodeling phases of healing. However, dysregulated wound healing can overstimulate fibrotic activity, resulting in the development of hypertrophic or keloid scars. These scars present a significant clinical challenge, as hypertrophic scars develop in more than 70% of burn survivors with a 40%-94% incidence rate following surgery. While hypertrophic and keloid scars are a common health concern, treatment options are limited due to the complex nature of pathological scar development. Furthermore, the development of new therapeutics is complicated by limitations in research models mimicking scars in vitro and in vivo. We present a review of the available therapeutic strategies and clinical data addressing fibrotic scars, in vitro and in vivo models, and methods used to study scars. We then summarize recent clinical trial data addressing hypertrophic scars. Lastly, we discuss the translatability of hypertrophic scar research to other pathological scars, such as mechanically weak scars and scars from spinal cord injury-induced pressure wounds that increase the risk of wound recurrence after healing in certain types of wounds. Findings identify several early inflammatory signaling targets to investigate for the improvement of hypertrophic scarring.