TREATMENT GUIDE |
treatment guide Scar reduction
Gerd G. Gauglitz reviews the treatment options available for the reduction of scar appearance, including topicals, injectables, and laser and light-based devices
scar appearance, and value even small improvements in scarring as clinically meaningful. Based on the current guidelines available for the treatment of keloids and hypertrophic scars, a variety of techniques may be used in order to improve appearance and symptoms of unpleasant scars. Based on the most recent recommendations the following options show most benefit.
S
Silicone gel (sheeting) Silicone sheets are being used 12–24 hours per day over a period of 12–24 weeks1
, and
beginning 2 weeks after wounding. Currently
published studies
predominantly conclude positively in favour of the evaluated silicone-based
CARRING FOLLOWING surgery or trauma is difficult to predict and both physicians and their patients
are highly concerned with minimising therapy. A recent Cochrane review2 ,
however, determining the effectiveness of silicone gel sheeting in the treatment and prevention of keloid and hypertrophic scarring, concluded that most studies are of poor quality. Therefore, the ultimate efficacy of silicone gel sheets remains unclear. An increasing body of literature supports the use of silicone gels for prophylaxis of unpleasant scarring, particularly in areas of consistent movement where sheeting will not conform3–7
. The
ultimate benefit of silicone gels on mature hypertrophic scars and keloids, however, remains contradictory.
Intralesional corticosteroid injections and cryotherapy Currently, intralesional triamcinolone acetonide represents the therapy of
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76 ❚ June 2013 |
prime-journal.com
Indications IPL skin treatments, hair removal, telangiectasia, vascular lesions, haemangiomas, port wine stains, venous malformations, angiomas, leg and reticular veins, solar lentigines, wrinkles, striae, scars, dyschromia, pigmented lesions, warts, skin resurfacing, acne scars and much more.
Availability Worldwide
choice for small and younger keloids, as well as hypertrophic scars1, 8
. Three to four Currently, intralesional
triamcinolone acetonide represents the therapy of choice for small and
younger keloids, as well as hypertrophic scars.
injections of triamcinolone acetonide (TAC; 10–40 mg/ml) every 4 weeks are usually sufficient, although injections may continue for 6 months or more9
. Side-effects
include dermal atrophy, telangiectasia, and pain at the injection site. The latter can be averted by topical anaesthesia
and/or
regional injections of local anaesthetic around or underneath the scars to be injected10
. For older
hypertrophic scars and larger keloids, combination treatment with cryotherapy appears more effective11, 12
, and currently
represents the most widely used modality in daily routine. The author usually performs cryotherapy directly before the injection of TAC, since success rates appear to be increased based on the
Contact
www.aesthetic.lumenis.com
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