Hypertrophic Scars: A Retrospective Review of Etiologies, Treatments, and Outcomes

Abstract

PURPOSE: We conducted the current study to review our clinical experience managing hypertrophic scars. Our primary aim was to investigate the outcomes of nonsurgical and surgical treatments intended to remove or reduce hypertrophic scars. The secondary aim was to investigate anatomical locations and nonsurgical and surgical treatments between burn and nonburn etiologies of hypertrophic scars. Tertiary aims were to assess responses to therapy and recurrence rates associated with different laser settings. METHODS: A retrospective analysis of a consecutive cohort of patients whose hypertrophic scars were managed and followed up in clinic from January 1, 2017 to January 1, 2019. Patients were included if they were ≥18 years of age and had a documented diagnosis of a hypertrophic scar. Patients were excluded if they did not follow-up after hypertrophic scar treatment or if they had a keloid scar diagnosis. Primary outcomes measured were hypertrophic scar treatment modalities and corresponding changes in pain scores, changes in pruritus scores, and recurrence rates following treatments. Secondary outcomes measured were scar locations, previous treatments, previous surgery in scar location, subsequent treatments, and postsurgical adjuvant therapy between burn and nonburn etiologies. Tertiary outcomes measured were responses to therapy and recurrence rates associated with laser types, settings and handpiece options. RESULTS: One hundred forty-two patients (mean age, 40.6 ± 15.9 years) had 595 hypertrophic scars. Median length of follow-up was 10.1 months (interquartile range, 7.3–14.8 months). Surgery or lasers were associated with significant changes in pruritus scores compared to corticosteroid injections or topical steroids alone (P = 0.01). Lasers or corticosteroid injections were associated with significantly lower recurrence rates compared to surgery or topical corticosteroids alone (P = 0.03). Lasers significantly increased the odds of decreased pain scores (odds ratio, 1.03; 95% CI, 0.1–1.9; P = 0.023) and no changes in pruritus scores. Lasers significantly reduced the odds of scar recurrence (odds ratio, 0.12; 95% CI, 0.04–0.41; P = 0.001). Burn scars were more commonly located on the face/head (15% versus 7.5%; P < 0.001), upper arm/forearm (40.5% versus 12.3%; P < 0.001), posterior torso (6.5% versus 1.9%; P = 0.005), and thigh/leg (15% versus 1.9%; P < 0.001) compared to nonburn scars. Nonburn scars were more commonly located at the hands compared to burn scars (14.1% versus 7%; P = 0.007). Burn scars were more commonly treated with lasers compared to nonburn scars (98.8% versus 19.9%; P < 0.001). Nonburn scars were more commonly treated with surgery (18.8% versus 10.2%; P = 0.03) and corticosteroid injections (75.5% versus 0.8%; P < 0.001) compared to burn scars. Different laser handpiece options were significantly associated with successful responses to therapy (DeepFX = 100%, SCAAR FX = 65.8%, and ActiveFX = 48%; P = 0.014). CONCLUSIONS: Lasers increased the odds of decreased pain scores and no changes in pruritus scores for all etiologies of hypertrophic scars. Laser use reduced the odds of scar recurrence for all etiologies of hypertrophic scars. Hypertrophic burn scars were more commonly located on the face/head, upper arm/forearm, posterior torso, and thigh/leg, whereas hypertrophic nonburn scars were more commonly located on the hands. Hypertrophic burn scars had the greatest response rates with the laser handpiece DeepFX.