Special Topics
November 2006

Treatment of Keloids and Hypertrophic ScarsA Meta-analysis and Review of the Literature

Author Affiliations

Author Affiliations: Department of Otolaryngology—Head & Neck Surgery, Jefferson Medical College, and Center for Facial Plastic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa.

Correspondence: David Reiter, MD, DMD, 925 Chestnut St, Sixth Floor, Philadelphia, PA 19107 (David.Reiter@jefferson.edu).


Copyright 2006 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2006

Arch Facial Plast Surg. 2006;8(6):362-368. doi:10.1001/archfaci.8.6.362

Management of hypertrophic scars and keloids has advanced from crude, invasive methods such as gross excision and radiation to intralesional or topical agents that act on a cellular level. There is no universally accepted treatment regimen and no evidence-based literature to guide management. Our objectives are to present a list of available treatment regimens, their proposed mechanisms of action, and supporting evidence and to perform a meta-analysis of clinical trials to identify treatments with a better-than-even likelihood of improvement. We conducted a PubMed search through October 2005, identifying clinical studies of various treatments for hypertrophic scars and keloids. We graded the quality of each study, delineated the results into favorable vs nonfavorable, and calculated the statistical significance of the findings. The meta-analysis of 70 treatment series for various clinical measures showed a 70% chance of improvement with treatment; however, the mean amount of improvement to be expected was around 60%. There was no statistically significant difference between treatments. Most treatments for keloidal and hypertrophic scarring offer minimal likelihood of improvement. The magnitude of likely permanent improvement in any sign or symptom may be clinically meaningful but far short of cure. Novel therapies deserve further investigation but remain without proven benefit to date.