The following are the main non-surgical treatments commonly used for scarring: 1. Laser therapy: CO2 laser was the first laser used to treat scarring, mainly through laser cauterization, vaporization or carbonization of the scar to remove the scar, but the efficacy is poor and the recurrence rate is high. Then argon laser and Nd:YAG laser were put into application and achieved certain effect. At present, the application of ultra-pulsed carbon dioxide laser, fractional laser and pixel laser has greatly improved the efficacy and is one of the methods chosen for superficial scars.
2.Cryotherapy: It is to use freezing agent to destroy the scar tissue cells and blood microcirculation to make them necrotic and fall off, and at the same time can lead to scar tissue edema and cell gap increase, scar density decrease, so that drug intra-scar injection is easier and more effective. It is suitable for small area keloid and hyperplastic scar.
3. Radiation therapy: Both superficial X-rays and β-rays can significantly reduce the number of fibroblasts, impair their function, reduce the synthesis of collagen fibers and matrix, and increase the decomposition, allowing the scar to become flat and soft. The main indications are keloids and hyperplastic keloids that are unwilling to undergo surgery or are not suitable for surgery. The treatment method is to irradiate once every 1~2 weeks, 300~500 rad each time, 4~6 times in a row for a course of treatment.
4. Intra-scar drug injection therapy: Corticosteroids are widely used at home and abroad for the treatment of hyperplastic keloid scars and keloid scars. Their mechanism of action is to inhibit the synthesis of collagen alpha-peptide chain and prolyl hydroxylase to reduce collagen synthesis, and at the same time can induce fibroblasts to produce collagenase to increase collagen degradation. For small proliferative keloids or keloid scars, the commonly used drugs are tretinoin and Depo-Provera. Only a few drugs in the biologics class, such as interferon and hyaluronidase, are available for clinical use. Antineoplastic drugs such as 5-fluorouracil (5-FU) and cetepe, and the antiallergic drugs trinostat (Tranilast) and benadryl are also used in the treatment of keloid scars. At present, most of these drugs are used clinically in combination with local injection within the scar.
5. Traditional Chinese Medicine (TCM): with a long history, the main treatment methods are internal treatment, such as the use of Fuyuan and Blood Activation Soup with addition and subtraction, and oral administration of cumene tablets; external treatment, which is the main method for scar treatment, such as the use of black cloth ointment paste, cumene ointment, and scar itching softening cream for external application; combined method of internal and external treatment, such as internal administration of elimination and drainage soup and external application of Ganwu powder. It is suitable for the systemic and local treatment of various kinds of keloid scars.
6.Molecular therapy: The more promising methods of using biological molecules to treat keloid scars are gene therapy and anti-transformation growth factor beta therapy, which are still in the experimental stage.