Updated international clinical recommendations on scar management: part 1--evaluating the evidence.

BACKGROUND: There is an ongoing need to standardize scar management by establishing safe and effective treatment options that can be applied in routine clinical practice. OBJECTIVE: To review available data on methods for preventing and treating cutaneous scarring. MATERIALS AND METHODS: Relevant scientific literature was identified through a comprehensive search of the MEDLINE database. Additional data and published studies were submitted for consideration by members of the International Advisory Panel on Scar Management. RESULTS: One of the most significant advances in scar management over the past 10 years has been the broader application of laser therapy, resulting in a shift in status from an emerging technology to the forefront of treatment. Accumulated clinical evidence also supports a greater role for 5-fluourouracil in the treatment of hypertrophic scars and keloids, particularly in combination with intralesional corticosteroids. Encouraging data have been reported for newer therapies, including bleomycin, onion extract-containing preparations, imiquimod, and mitomycin C, although methodologic limitations in available studies merit consideration. In general, clinical and aesthetic outcomes seem to be enhanced by a combination approach to treatment. CONCLUSION: Advances in therapeutic options and new study data necessitate a revision of algorithms for the prevention and management of cutaneous scarring.