Keloids and hypertrophic scars in individuals with darker Fitzpatrick skin types: a systematic review of treatment efficacy and quality of life outcomes.

importanceKeloids and hypertrophic scars (HTS) can cause physical discomfort and- psychosocial distress, especially in individuals with darker Fitzpatrick skin types. These scars often recur and may lead to itching, pigmentation changes, pain, and reduced self-esteem.

objectiveTo examine how keloids and HTS affect quality of life (QoL) in darker-skinned populations and to evaluate treatment strategies that may improve both scar outcomes and QoL. EVIDENCE REVIEW: We conducted a systematic review in April 2024 using PubMed, Scopus, and Embase. Two independent reviewers screened studies based on predetermined criteria, with a third resolving discrepancies. The Methodological Index for Non-Randomized Studies (MINORS) scale

findingsFrom 132 initial publications, 14 studies met the inclusion criteria. Surgical excision followed by brachytherapy showed recurrence rates of about 3.1% for keloids. Combining silicone gel sheeting, intralesional corticosteroids, laser therapy, and pressure therapy was generally more effective for HTS. While only a few studies included formal QoL assessments, improvements in pain, pruritus, and overall patient satisfaction were reported. Notably, darker Fitzpatrick skin types were underrepresented in existing scar severity scales, pointing to a gap in tailored outcome measures. CONCLUSIONS AND RELEVANCE: Treatments such as surgical excision followed by brachytherapy appear promising for keloids, and multimodal approaches may yield better outcomes for HTS. However, potential side effects like hyperpigmentation must be considered. More inclusive research with standardized QoL measures is needed to clarify how these interventions influence both scar resolution and overall well-being in darker-skinned populations.