Papers of The 9th Japan Scar Workshop

10. Toward the improvement and creation of the JSW Scar Scale 2011

Yasuyoshi Tosa, Tomoaki Kuroki, and Shinya Yoshimoto
Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo, Japan

In response to the interim draft report of 2009, the JSW Scar Scale 2011 was created at the 2011 Japan Scar Workshop by the JSW Scar Scale Working Group with multicenter use and repeated review.
The current JSW Scar Scale 2011 is divided into Classification (for grading and selection of appropriate treatment methods) on the left side, and Evaluation (for the judgment of results and follow-up) on the right side. The left side consists of 12 items: race, familial tendency, number, region, age at onset, causes, size, vertical growth, horizontal growth, shape, erythema around scars, and subjective symptoms (pain/itching). A total score of 0 - 25 is classified as normal scar characteristics (0 - 5), hypertrophic scar characteristics (5 - 15), or keloid characteristics (15 - 25). The right side has six items: induration, elevation, redness of scars, erythema around scars, spontaneous and pressing pain, and itching. These are graded as none, weak, mild, or strong, and scored 0, 1, 2, or 3, respectively. The total score can range from 0 to 18 and is used to evaluate the results and for follow-up.
We describe use of the JSW Scar Scale 2011 and what was observed. A family with a strong predisposition for keloids has a high risk of being difficult to treat, but is one point for familial tendency in this scale appropriate? There are cases of refractory keloids of more than 5 or 10 years. Reflecting keloid predisposition is an important factor in the advisability and risks of surgery. Is it acceptable not to pay attention to the course that previous scars on the body surface took? Are two points for erythema around scars in this scale appropriate?
In the classification of predisposition, it is considered important that the score reflecting a "true keloid" is not too low.
The JSW Scar Scale 2011 is simple and reproducible, a good tool that is very easy to use in many facilities, and can be shared across disciplines. It is important to accumulate data using the same tool for many years at multiple facilities. We think the score reflecting keloid predisposition is somewhat proportionally small in the current scale. If there is an opportunity to modify this tool in the future, our view is that there is room to review the proportion of points for familial history, the patient's own history of scars, and erythema around scars.
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