Hypertrophic scarring remains a problematic issue for patients and clinicians. Its prevalence is thought to be about 70% after burns, which leads to pain, itching and loss of joint mobility. The exact mechanisms underlying hypertrophic scar formation remain unclear, and clinical options remain limited.

Several studies have demonstrated pathological scars are a sort of hyperactive vascular response to wounding. Scar regression is accompanied by microvessel occlusion, which results in severe hypoxia, malnutrition and endothelial dysfunction, symbolizing the essential roles of microvessels in scar regression. Thus, interventions targeting vasculatures, like intense pulsed light, pulsed dye lasers, vascular endothelial growth factor antibodies and Endostar, depict potential treatments. Additionally, the current treatments dont consider the mass of scar-associated collagen. However, collagen-targeted therapies like fractional CO₂ laser and collagenase have shown favorable results in scar treatment.

Traditional modalities employed in current clinical practice only partly target scar-associated microvessels or collagen, limiting the effectiveness of current treatments, which are also frequently accompanied by undesirable side effects. The scar construction in the early stage is primarily influenced by microvessels, while that in later stages is mainly comprised of residual collagen. Traditional therapies do not use specific targets for scars at different stages. Hence, more meticulous treatment strategies are needed.

It is crucial to classify scars as either "vascular-dominant" or "collagen-dominant" before selecting a treatment. It will help recommend strategies that are vascular-targeted, collagen-targeted or a combination thereof to treat scars at different stages.

Source: Yuan B, Upton Z, Leavesley D, Fan C, Wang XQ. Vascular and collagen target: a rational approach to hypertrophic scar management. Adv Wound Care (New Rochelle). 2023;12(1):38-55.