Reaching Zero Burn Scars: A Review of the Efficacy of Corticosteroids in Treating Scar Contractures


Jeremy Bishay1, Isobel Yeap1, Akane Katsu2, Aruna Wijewardana1, Bishoy Soliman1,
1Severe Burns Injury Unit, Royal North Shore Hospital, St Leonards , NSW, Australia
2Department of Occupational Therapy, Royal North Shore Hospital, St Leonards, NSW, Australia

Abstract

Purpose:
Despite advances in burn care, the management of burns remains a challenging task. Among the common sequalae of burns, the development of scar contractures presents a vexing challenge given the potential for functional impairment and aesthetic disfigurement. Corticosteroids have emerged as a treatment for the management of burn scar contractures.

Methodology:
First, we present a literature review, highlighting the efficacy of corticosteroids in mitigating scar thickness as well as ameliorating the pruritus and pain associated with scars. Second, we present the case of a 38-year-old female with 55% TBSA burns, who developed scar contractures involving her lower lip and axilla. Corticosteroid therapy was initiated at 3 months and noteworthy improvements were observed in both lower lip function and axillary range of motion.

Results:
Corticosteroids have demonstrated potent anti-inflammatory effects as well as the ability to prevent collagen deposition and promote collagen degradation (1). A 2022 meta-analysis of 23 RCT’s found that corticosteroids effectively reduced hypertrophic scars and keloids, with an impressive regression rate of 50-100% (1). Moreover, a 2020 prospective RCT of 50 burn survivors demonstrated that corticosteroids led to a substantial reduction in scar thickness and improvement in elasticity (1). However, the potential for adverse effects, such as skin atrophy and infection, must be considered when using corticosteroids (1).

Conclusion:
In conclusion, corticosteroids have shown promising results in the management of burn scar contractures. However, the existing literature lacks a definitive consensus on the ideal timeframe to initiate therapy. Therefore, further studies should focus on addressing this gap in the literature to refine treatment guidelines and optimise patient outcomes.

References:
(1) Ogawa R, N 2022, ‘The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago’, Plast Reconstr Surg, vol 149, no. 1, pp. 79-94.

Biography

Jeremy Bishay is a Craniofacial Surgery Research Fellow at Prince of Wales Hospital with a keen interest in Plastic and Reconstructive Surgery