The Efficacy of Pressure Garments, Silicone, and Combination Therapies in The Prevention and Treatment of Hypertrophic Scars: A Systematic Review

Background: This systematic review evaluated the effectiveness of pressure therapy, silicone-based treatments, and their combination in the prevention and management of hypertrophic scars. Methods: A systematic search of PubMed, Scopus, Cochrane Library, CENTRAL, Wiley, EBSCO, and ProQuest was conducted on May 2, 2024. Study quality was assessed using the CEBM randomized controlled trial appraisal sheet and the GRADE approach. The review protocol was registered in PROSPERO (CRD42021248080). Results: Six randomized controlled trials involving 383 predominantly adult patients were included, with burn injury as the most common scar etiology. Three studies evaluated preventive interventions, two focused on treatment, and one addressed both prevention and treatment. Three studies demonstrated a low risk of bias, while the remaining studies had a moderate risk of bias. Combined silicone–pressure garment therapy (PG) was not consistently superior to PG alone. No significant differences were observed among treatment modalities for scar vascularity, pain, or pruritus. However, two studies reported significantly greater improvements in scar pliability with combined therapy compared with PG alone. Findings related to scar thickness and pigmentation were inconsistent. Conclusions: Combined PG and silicone gel sheeting may improve scar height and pliability in established hypertrophic scars, although the overall certainty of evidence remains low. No significant differences were observed among PG, topical silicone, or their combination for scar prevention, supporting individualized treatment decisions and the need for further high-quality studies with larger sample sizes.