Hypertrophic Scar Severity and Clinical Management in the Real-World Dermatology Setting

OBJECTIVES: To characterize hypertrophic scar management by severity in the real-world dermatology setting.
METHODS: Outpatient electronic health records (2017-2024) from 6 specialty dermatology networks in the OMNY Health real-world data platform were accessed, and patients were selected if they had at least 1 scare assessment scale (ScAS) measurement (no noticeable scar, flat scar, raised scar, or nodular scar) associated with a hypertrophic scar diagnosis code. Additional diagnoses, prescriptions, and procedures were assessed at the same visit as the ScAS measurement. Proportions of patients by ScAS were calculated for comorbid dermatologic conditions and common treatment strategies.
RESULTS: A total of 21,726 patients with 28,779 ScAS measurements were included (1% no noticeable scar, 22% flat scar, 61% raised scar, 16% nodular scar). Distributions of gender (64% female), race (25% nonwhite), ethnicity (10% Hispanic or Latino), and age (mean: 46 years; standard deviation: 21 years) were similar across ScAS categories. Top comorbid dermatologic conditions were melanocytic nevi (27%), seborrheic keratosis (22%), melanin hyperpigmentation (19%), hemangioma (15%), and actinic keratosis (12%) and similar across ScAS categories. Topical corticosteroids and 5-fluorouracil injections also did not vary across ScAS categories and were used in 11% and 1% of encounters, respectively. For patients with no noticeable scar, flat scar, raised scar, and nodular scar, laser therapy was used in 5%, 9%, 7% and 5% of encounters, and cryotherapy was used in 13%, 11%, 10%, and 5% of encounters, respectively. Documentation of steroid injections, pressure therapy, scar massage therapy, radiation therapy, and microneedling during routine practice was negligible.
CONCLUSIONS: Hypertrophic scar severity did not seem to influence clinical management for most treatment strategies; although, cryotherapy decreased monotonically with increasing scar severity. Analyses of clinical notes and linked claims may be beneficial to understand if more invasive procedures or treatments were implemented outside of the specialty dermatology setting.