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.