Multimodal Treatment of Hypertrophic and Keloidal Scars

Abstract

Introduction: Hypertrophic and keloidal scars are unwanted sequelae of wound healing. As multiple pathologic progenitors and mediators are responsible for these abnormal scars, single modality therapy is only intermittently successful. Multiple empiric therapies are now available which can be applied concomitantly or sequentially to address these uncomfortable and unsightly conditions. Materials and Methods: A 76-year-old woman underwent a rhytidectomy and blepharoplasty followed by perioral ablative laser resurfacing. During the ensuing 4 months, she developed circumferential perioral hypertrophic scars with foci of keloidal scar formation plus secondary evolution of microstomia. Results: Over an 18-month period, the patient received a single course of imiquimod cream, multiple injections of 5-fluorouracil and triamcinolone, multiple intense pulsed light treatments, and multiple nonablative fractional laser resurfacing treatments. At the conclusion of therapy, the patient achieved more than 90% resolution of hypertrophic and keloidal scarring. Conclusions: While knowledge of the pathogenesis of hypertrophic and keloidal scarring is evolving, at tempts at its resolution are empirical. Not surprisingly, the processes by which various therapies are effective continue to be argued. Nonetheless, administering multimodal therapy in an artful sequence can ameliorate many if not most hypertrophic and keloidal scars when treated at a relatively early stage.