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Update on Scar Management: Guidelines for Treating Asian Patients

Kim, Sukwha M.D., Ph.D.; Choi, Tae Hyun M.D., Ph.D.; Liu, Wei M.D., Ph.D.; Ogawa, Rei M.D., Ph.D.; Suh, Jeong Seok M.D.; Mustoe, Thomas A. M.D.

Plastic and Reconstructive Surgery: December 2013 - Volume 132 - Issue 6 - p 1580–1589
doi: 10.1097/PRS.0b013e3182a8070c
Reconstructive: Trunk: Special Topic

Background: Following injury, Asian skin has a tendency towards hyper-pigmentation and scar formation, and therefore the prevention of scarring is particularly important in Asian patients. Since publication of an International Clinical Recommendation on Scar Management in 2002, there have been numerous publications in the field of scar management. Advances in understanding scar formation have also led to the introduction of new treatments as well as a better understanding of established therapeutic options.

Methods: A literature search for abstracts, clinical trials and meta-analyses evaluating scar prevention and treatment was performed using PubMed and the Cochrane Database of Systematic Reviews. Based on this data a panel of experts formulated treatment recommendations for Asian patients.

Results: Following surgery, scar prevention should be initiated in all Asian patients due to the high risk of poor scars. There is strong evidence for the efficacy of silicone based products, and due to their ease of use, they can be considered first-line therapy. Silicone gel (versus silicone gel sheets) products have demonstrated efficacy. For patients who fail to respond to first-line therapy, intralesional steroid injections, radiation therapy, and intralesional 5-flourouracil injections have achieved widespread acceptance. Laser treatments have been increasingly used, although the evidence remains largely anecdotal without a clear consensus on optimal wavelength, or amount of energy. Surgical approaches have increased in sophistication with recognition of the impact that tension has on scar formation.

Conclusion: Updated scar management recommendations will benefit practitioners making decisions regarding optimal, evidence-based treatment strategies for their patients.

Seoul, Korea; Shanghai, People’s Republic of China; Tokyo, Japan; and Chicago, Ill.

From the Department of Plastic and Reconstructive Surgery and the Institute of Dermatological Science, College of Medicine, Seoul National University; the Department of Plastic and Reconstructive Surgery, Shanghai 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School; and the Division of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.

Received for publication December 16, 2012; accepted May 28, 2013.

Disclosure: Drs. Mustoe and Kim have received honoraria from A. Menarini Asia Pacific for two speaking trips in Asia. Drs. Liu, Ogawa, and Choi have received both honoraria and a travel grant from A. Menarini Asia Pacific as speakers in Asia. Medica Communications Pte Ltd provided writing and editorial support, which was funded by an unrestricted grant from A. Menarini Asia Pacific. Authors were not paid honorarium in the course of article development.

Tae Hyun Choi, M.D., Ph.D., Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, 101 Daehang-Ro, Jongno-Gu, Seoul 110-744, Republic of Korea, psthchoi@snu.ac.kr

Thomas A. Mustoe, M.D., 675 North St. Clair, Suite 19-250, Chicago, Ill. 60611, tmustoe@nmh.org

©2013American Society of Plastic Surgeons