Wound healing after dermal injury is an imperfect\nprocess, inevitably leading to scar formation as the\nskin re-establishes its integrity. The resulting scars have\ndifferent characteristics to normal skin, ranging from fineline\nasymptomatic scars to problematic scarring including\nhypertrophic and keloid scars. Scars appear as a different\ncolour to the surrounding skin and can be flat, stretched,\ndepressed or raised, manifesting a range of symptoms\nincluding inflammation, erythema, dryness and pruritus,\nwhich can result in significant psychosocial impact on\npatients and their quality of life. In this paper, a comprehensive\nliterature review coupled with an analysis of\nlevels of evidence (LOE) for each published treatment\ntype was conducted. Topical treatments identified include\nimiquimod, mitomycin C and plant extracts such as onion\nextract, green tea, Aloe vera, vitamin E and D, applied to\nhealing wounds, mature scar tissue or fibrotic scars following\nrevision surgery, or in combination with other\nmore established treatments such as steroid injections and\nsilicone. In total, 39 articles were included, involving\n1703 patients. There was limited clinical evidence to\nsupport their efficacy; the majority of articles (n = 23)\nwere ranked as category 4 LOE, being of limited quality\nwith individual flaws, including low patient numbers,\npoor randomisation, blinding, and short follow-up periods.\nAs trials were performed in different settings, they were\ndifficult to compare. In conclusion, there is an unmet\nclinical need for effective solutions to skin scarring, more\nrobust long-term randomised trials and a consensus on a\nstandardised treatment regime to address all aspects of\nscarring.
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