Consensus on energy-based devices for keloids and hypertrophic scars: A Latin American Delphi study

Viana de Oliveira G.; Druck P.A.; Acevedo A.A.L.; Hexsel D.; Gontijo G.T.; Rivera G.H.; Velázquez-Arenas L.L.; Addor F.A.S.A.; Zaputovich F.A.; Leal-Silva H.; Leal-Delgado S.; Escribens C.E.; Murillo K.D.O.; Misticone S.; D'orsi Metsavaht L.; de la Riva J.; Galimberti D.R.; Jedwab S.K.K.; Garcia H.R.G.; Silva M.R.E.; Andrade M.R.; Reis-Filho E.; Silva M.R.; Krompouzos G.; Guzmán-Sánchez D. · Journal of the European Academy of Dermatology and Venereology (2026) · DOI: 10.1111/jdv.70636

Resumen

Background: Keloids (KSs) and hypertrophic scars (HSs) occur more frequently in populations with higher and mixed skin phototypes, such as those in Latin America. While lasers and other energy-based devices (EBDs) have broadened therapeutic options for scar management, their use in darker and genetically diverse populations presents specific challenges, especially concerning pigmentary complications and treatment safety. Objective: This study aimed to develop a consensus among Latin American experts on the safe and effective use of lasers, EBDs and combination therapies for managing KSs/HSs. Methods: A Delphi-based consensus process was conducted among 22 Latin American dermatologists specialized in scar management. The experts evaluated 23 representative clinical scenarios over three anonymous iterative rounds. They selected first- and second-line treatments from a predefined list of therapeutic options, which included lasers, injectables, dressings and adjunctive therapies. Consensus was defined in advance using established agreement thresholds. Results: Consensus was reached for nearly all (21 of 23) clinical scenarios. Early and inflammatory scars were primarily treated with vascular-targeting devices, silicone or hydrocolloid dressings and low-level light therapy. Actively growing KSs/HSs were primarily treated with intralesional corticosteroids combined with 5-fluorouracil or bleomycin, often integrated with vascular lasers or occlusive dressings. Fractional lasers were recommended primarily to improve texture after scar flattening, whereas pigment-targeting modalities were preferred to address residual dyschromia. Combination therapies were consistently preferred over monotherapies, and specific safety recommendations were established for individuals with higher skin phototypes. Conclusions: This consensus provides population-adapted guidance for the multimodal management of scars in Latin American patients and may improve outcomes while minimizing adverse effects.

Instituciones: Universidad Nacional Mayor de San Marcos