Keloid/Hypertrophic Scar · Conservative vs Excision + Adjuvant

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] Type + prior treatment
   Hypertrophic scar or keloid? Prior treatment?
   • Hypertrophic scar/small keloid, not adequately treated conservatively → First-line conservative
   • Active inflammation/predominantly itch and pain → Active phase → intralesional injection
   • Refractory/large keloid, conservative failure → Refractory/large → excision + adjuvant
2. [End] First-line conservative
   First-line conservative: silicone sheets/gel, pressure therapy, scar massage; often effective for early/hypertrophic scars; use sun protection.
3. [End] Active phase → intralesional injection
   Itch/pain/erythema active phase → intralesional corticosteroid injection (± 5-FU/bleomycin), may combine with cryotherapy; usually several sessions.
4. [End] Refractory/large → excision + adjuvant
   Refractory/large keloid, conservative failure → surgical excision + adjuvant (postoperative radiotherapy or intralesional steroid/pressure) to lower recurrence; excision alone has a high recurrence rate — always combine with adjuvant therapy.

Source guidelines & references

• Scar management (international clinical scar management recommendations; silicone/steroid injection/excision + adjuvant)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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