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Evidenced-Based Strategies for Management of Pathologic Scars in Ethnic Skin

Rosevine Azap, MD1, Lauren Lowe, BS2, Mbinui Ghogomu, BS1, Camille Cash, MD3 and Wilmina Landford, MD4,5, (1)University of Texas Medical Branch, Galveston, TX, (2)Columbia University Vagelos College of Physicians and Surgeons, New York, (3)Camille G. Cash, MD: Aesthetic Plastic Surgery & Medical Spa, Houston, TX, (4)Johns Hopkins University School of Medicine, Baltimore, MD, (5)Landford Plastic Surgery, Baltimore, MD
Goals/Purpose

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Pathological scarring presents unique challenges for individuals with ethnic skin globally due to the functional, psychosocial, and cosmetic implications that may arise. As such, plastic and reconstructive surgeons play a pivotal role in addressing these concerns. While previous research has addressed scar management following trauma and medical procedures, limited data currently exists on optimal treatment strategies specifically for ethnic skin. This study aimed to identify current treatment modalities and develop evidence-based management strategies tailored for pathological scars in individuals with ethnic skin.

Methods/Technique

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A systematic literature search was used to identify studies on scar management in ethnic skin between 2012 and 2024. The search terms included (“ethnic skin” AND (“cicatrix” OR “scar” or “hypertrophic” OR “keloid”) AND (“prevention” OR “control” OR “keloid” OR “surgery” OR “therapy” OR “revision” OR “management”)). Articles were excluded based on the following criteria: 1) animal studies, 2) studies published before 2012, 3) publications written in any languages other than English, 4) publications that did not address scar management in ethnic skin, and 5) original studies conducted in ethnic countries that did not specify the race/ethnicity of the studied groups. Key data extracted included patient demographics, scarring characteristics, treatment modalities, and reported outcomes.

Results/Complications

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A total of 232 studies were initially identified, with 20 studies meeting inclusion criteria. Among these, scar management in Asian skin was most frequently addressed, with two studies focused on individuals of African descent. Effective management strategies emphasized perioperative care, such as preoperative history-taking and physical exams, prompt suture removal, and vigilant postoperative wound care. Intralesional triamcinolone injections were the first-line treatment in managing keloids and hypertrophic scars. Interestingly, combination therapy, including the use of Er:YAG and Nd:YAG, in addition to non-surgical modalities, such as corticosteroid and 5-fluorouracil injections, have been found to be effective in treating pathologic scars in ethnic skin. In high-mobility areas, botulinum toxin injections and the use of silicone gel products were recommended to avoid movement and stretching. It was demonstrated that combination therapy with surgical and non-surgical modalities were most effective for managing hypertrophic and keloid scars in ethnic skin.

Conclusion

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In conclusion, several therapeutic modalities, including surgical and non-surgical therapies, exist to manage pathological scars in ethnic skin. More studies are needed to assess the efficacy of different treatments for pathologic scars stratified by different types of ethnic skin.

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