Scar management in pediatric patients: a current review

Abstract

Pediatric patients are particularly vulnerable to trauma and surgical interventions, both of which frequently result in cutaneous scarring. Although the complete prevention of injuries is not feasible, scar formation and long-term sequelae can be mitigated through evidence-based interventions. Current literature highlights that optimal scar management begins intraoperatively, with meticulous attention to reducing wound tension by aligning incisions along relaxed skin tension lines and achieving early closure under minimal stress. Postoperative strategies should be initiated within 2 to 3 weeks following wound closure and typically involve the use of silicone-based therapies (gels or sheeting) in combination with manual scar massage. Nevertheless, emerging evidence indicates that topical modalities alone may be insufficient in cases of erythematous or immature hypertrophic scars, where laser therapy has demonstrated superior outcomes. Pathological scar evolution—including atrophic scars, post-inflammatory hyperpigmentation, hypertrophic scars, and keloids—necessitates multimodal therapeutic approaches tailored to scar phenotype. For instance, atrophic scars may benefit from retinoid application and dermabrasion, whereas hyperpigmented lesions respond more favorably to retinoids, hydroquinone, and selective laser therapies. Hypertrophic scars and keloids require more intensive protocols, incorporating pressure therapy, intralesional corticosteroids, and laser-based interventions. In cases where pathological scarring persists beyond 12 months despite conservative and adjunctive therapies, surgical excision remains an appropriate intervention. Importantly, current evidence supports a stepwise, algorithmic approach to pediatric scar management, integrating preventive strategies, topical and device-based therapies, and surgical revision as clinically indicated.