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Updated International Clinical Recommendations on Scar Management: Part 1—Evaluating the Evidence

BACKGROUND There is an ongoing need to standardize scar management by establishing safe and effective treatment options that can be applied in routine clinical practice. OBJECTIVE To review available data on methods for preventing and treating cutaneous scarring. MATERIALS AND METHODS Relevant scientific literature was identified through a comprehensive search of the MEDLINE database. Additional data and published studies were submitted for consideration by members of the International Advisory Panel on Scar Management. RESULTS One of the most significant advances in scar management over the past 10 years has been the broader application of laser therapy, resulting in a shift in status from an emerging technology to the forefront of treatment. Accumulated clinical evidence also supports a greater role for 5-fluourouracil in the treatment of hypertrophic scars and keloids, particularly in combination with intralesional corticosteroids. Encouraging data have been reported for newer therapies, including bleomycin, onion extract–containing preparations, imiquimod, and mitomycin C, although methodologic limitations in available studies merit consideration. In general, clinical and aesthetic outcomes seem to be enhanced by a combination approach to treatment. CONCLUSION Advances in therapeutic options and new study data necessitate a revision of algorithms for the prevention and management of cutaneous scarring.