The present study illustrates an evidence-based algorithm for preventing and treating hypertrophic scars and keloids. It evaluated all studies for methodologic quality and extracted the baseline characteristics of patients along with the interventions and their outcomes. 

The study explains:

• Risk factors for hypertrophic scar and keloid growth are local (tension on the wound/scar), systemic (like hypertension), genetic (like single-nucleotide polymorphisms) and lifestyle factors. 
• Scar contracture severity decides the treatment of hypertrophic scars: if severe, surgery remains the first choice; if not, conservative therapies are indicated. 
• Keloid treatment relies on whether they are small and single or large and multiple. 
• Small and single keloids can be managed radically by surgery with adjuvant therapy (like radiotherapy) or multimodal conservative therapy. 
• Volume- and number-reducing surgery is a choice for large and multiple keloids. 
• Irrespective of the treatment(s), it is essential to follow-up with the patients over the long-term. 
• Conservative therapies, like gel sheets, tape fixation, topical and injected external agents, oral drugs and makeup therapy, should be prescribed case by case.

This study explains that the randomized controlled trials on pathologic scar management have grown markedly over the past decade. Despite having various limitations, they have greatly improved hypertrophic scar and keloid management. High-quality trials will likely further improve the current hypertrophic scar and keloid treatment algorithms.

Source: Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg. 2022;149(1):79e-94e.