Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment.

BACKGROUND In 2002, an international advisory panel was convened to assess the scientific literature and develop evidence-based guidance for the prevention and treatment of pathologic scarring. Emerging clinical data, new treatment options, and technical advances warranted a renewed literature search and review of the initial advisory panel recommendations. OBJECTIVE To update the management algorithm for pathologic scarring to reflect best practice standards at present. MATERIALS AND METHODS Management recommendations were derived from clinical evidence amassed during a comprehensive literature search and from the clinical experience and consensus opinion of advisory panel members. RESULTS A combination approach using multiple modalities provides the maximum potential for successful treatment of hypertrophic scars and keloids. The advisory panel advocates a move toward more aggressive initial management of keloids, including earlier application of 5-fluorouracil. A growing body of clinical research supports a place in therapy for newer agents (e.g., bleomycin, onion extract, imiquimod, mitomycin C) and laser therapy (pulsed-dye, fractional) for scar management. CONCLUSION Prevention and treatment of pathologic scarring requires individualized care built upon the principles of evidence-based medicine and continues to evolve in step with technological and scientific advances.