Consensus on energy‐based devices for keloids and hypertrophic scars: A Latin American Delphi study

BACKGROUND: Keloids (KSs) and hypertrophic scars (HSs) occur more frequently in populations with higher and mixed skin phototypes, such as those in Latin America. While lasers and other energy-based devices (EBDs) have broadened therapeutic options for scar management, their use in darker and genetically diverse populations presents specific challenges, especially concerning pigmentary complications and treatment safety. OBJECTIVE: This study aimed to develop a consensus among Latin American experts on the safe and effective use of lasers, EBDs and combination therapies for managing KSs/HSs. METHODS: A Delphi-based consensus process was conducted among 22 Latin American dermatologists specialized in scar management. The experts evaluated 23 representative clinical scenarios over three anonymous iterative rounds. They selected first- and second-line treatments from a predefined list of therapeutic options, which included lasers, injectables, dressings and adjunctive therapies. Consensus was defined in advance using established agreement thresholds. RESULTS: Consensus was reached for nearly all (21 of 23) clinical scenarios. Early and inflammatory scars were primarily treated with vascular-targeting devices, silicone or hydrocolloid dressings and low-level light therapy. Actively growing KSs/HSs were primarily treated with intralesional corticosteroids combined with 5-fluorouracil or bleomycin, often integrated with vascular lasers or occlusive dressings. Fractional lasers were recommended primarily to improve texture after scar flattening, whereas pigment-targeting modalities were preferred to address residual dyschromia. Combination therapies were consistently preferred over monotherapies, and specific safety recommendations were established for individuals with higher skin phototypes. CONCLUSIONS: This consensus provides population-adapted guidance for the multimodal management of scars in Latin American patients and may improve outcomes while minimizing adverse effects.