Papers of The 2nd Japan Scar Workshop

16. The classification and treatment of hypertrophic scars and keloids

Yasuyoshi Tosa, Yoshiaki Hosaka, Kiyoaki Tsutsumi, Kaneshige Satoh, Toshiya Yokoyama, *Atsuomi Saiga
Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan

Hypertrophic scars are classified into two categories, high grade and middle or low grade, or by the term keloids in Japan (Ohura classification). Clinical diagnosis is difficult since the appearance varies depending on the stage (early, active, mature, etc.) and the mixing of hypertrophic scars and keloids. Overseas, the International Clinical Recommendations on Scar Management recognizes four grades of hypertrophic scars and classifies keloids as minor and major. Treatments include conservative therapy (oral administration of tranilast, local injection of adrenal cortical hormone, external use of ointments containing adrenal cortical hormone, occlusive therapy with silicone gel sheets, and application of silicone cushions), physical therapy (pressure treatment), surgical therapy, radiation therapy (electron beam irradiation), and cryotherapy (liquid nitrogen therapy). The objectives of treatment include flattening the elevated lesion, alleviation/elimination of itching and pain, reduction of redness, and release of scar contracture. These therapies, either alone or in combination, produce different therapeutic effects depending on the site, age, and clinical conditions. The method of evaluation was based on the report of Hirshowitz et al., with objective findings and subjective symptoms scored and improvement assessed. The occurrence of adverse events was also assessed.
Copyright(C) 2007 Japan Scar Workshop All rights reserved.