Combined treatment of hypertrophic and keloid scars

Objective: To analyze current scientific data on the pathogenesis, clinical manifestations, and evidence-based treatment methods for hypertrophic and keloid scars. We also aim to identify risk factors for their development and identify prevention strategies. Materials and Methods: An analytical review of publications from recent decades was conducted, including data from clinical, histopathological, and experimental studies. The mechanisms of inflammation in the reticular dermis were examined, the factors contributing to pathological scarring were analyzed, and the effectiveness of various treatment methods, including conservative, physical, injection, surgical, and adjuvant approaches, was assessed based on data from meta-analyses and large clinical reviews. Results: Long-term inflammation plays a key role in the formation of keloids. Hypertrophic scars, on the other hand, are characterized by transient inflammation and do not extend beyond the original wound. Keloids are characterized by increased expression of collagen types I and III, the presence of hyalinized collagen fibers, and two growth phenotypes. Silicone sheeting, corticosteroid injections, and their combination with 5-fluorouracil and laser therapy are recognized as the most effective treatment methods. Surgical excision is effective only with mandatory adjuvant therapy, including low-dose radiotherapy, enzyme therapy, and laser therapy. Prevention is aimed at accelerating epithelialization, reducing mechanical tension, and ensuring long-term stabilization of the immature scar. Conclusion: Pathological scars arise from chronic inflammation and the effects of various external and internal factors. The optimal treatment strategy should be individualized and comprehensive, with an emphasis on reducing inflammation and preventing recurrence. Cellular technologies remain a promising area that requires further research.