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A systematic review of randomized controlled trials in hypertrophic burn scar management

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eMediNexus    31 October 2020

Hypertrophic scars (HTS) are one of the causes of morbidity for burn survivors and can present itself with a variety of lifestyle-limiting difficulties such as pain, burning, pruritus, stiffness, and contractures. Several resolutions are developed, however only few are studied in the form of a prospective, randomized control trial (RCT).

Owing to the importance of these RCTs in affecting the treatment of burn patients, a systematic and critical review of the burn literature was conducted. Two separate searches using PubMed with limits including Humans, English, and Randomized Controlled Trial was done. Studies were reviewed and excluded if the management of burn HTS in the non-acute setting was not addressed.

32 articles were found in two literature searches. 12 articles were excluded as they were not relevant to the topic. The remaining 20 articles enclosed 882 patients who were treated for hypertrophic scars. Analysis based on topics involved laser therapy in 58 patients (2 articles), silicone gel in 204 patients(7 articles), compression garment in 236 patients(4 articles), silicone + pressure in 226 patients(3 articles), topical emollients in 58 patients(2 articles), systemic therapy in 62 patients (1 article), intralesional therapy in 18 patients (1 article), and surgical treatment in 20 patients (1 article). Few articles had favourable conclusions or unfavourable conclusions but conflicting results on silicone and/or compression were found.

The review concluded that even though hypertrophic scars is a common occurrence in burn survivors, the number of studies and treatment consensus are limited. Superior and adequately powered RCTs are required, specifically in the areas of compression garments, silicone and combination therapy.

Source: Friedstat JS, Hultman CS. Hypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials. Ann Plast Surg. 2014;72(6):S198-201. doi: 10.1097/SAP.0000000000000103. PMID: 24835874.

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