Interpretation of the Clinical Practice Guideline for the Prevention and Treatment of Scars in Children (2025 Edition)

doi:10.3969/j.issn.1674-8115.2026.05.001

Abstract

Abstract:

The physiological characteristics of children′s skin and their growth and development needs determine the particularity of pediatric scar management. However, there were no clinical practice guidelines for the prevention and treatment of pediatric scars worldwide previously. The Clinical Practice Guideline for the Prevention and Treatment of Scars in Children (2025 Edition), released by the Chinese Society of Burn Surgery of the Chinese Medical Association in 2025, is based on evidence-based medicine. Focusing on 10 key clinical issues in pediatric scar prevention and treatment, including wound management, pharmacological therapy, physical therapy, surgical treatment, rehabilitation intervention, and psychological support, the guideline formulates 20 recommendations and establishes an integrated guidance system covering the prevention-treatment-rehabilitation continuum for pediatric scars. Combined with its formulation background and features, the guideline provides detailed literature evidence in the interpretation section of the recommendations, emphasizes the inherent logic behind the development of these recommendations, and conducts a comprehensive and objective evaluation of currently controversial therapeutic methods in clinical practice. It can serve as a practical guide and reference for clinicians to standardize the prevention and treatment of pediatric scars. Based on the research progress in pediatric scar prevention and treatment, this article analyzes the key points of the guideline to facilitate better understanding and implementation.

Key words: child, scar, therapy, prevention, guideline interpretation

CLC Number:

R726.2

Chen Yunsheng, Deng Dan, Yuan Bo, Liu Yan. Interpretation of the Clinical Practice Guideline for the Prevention and Treatment of Scars in Children (2025 Edition)[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2026, 46(5): 561-567.

Figures/Tables 1

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References 25

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Recommendation	Interpretation
Wound factors in scar prevention and treatment for children	Given the correlation between wound healing time and the incidence of hypertrophic scars, systematic wound management aimed at promoting wound healing should be prioritized as the primary method for scar prevention and treatment. Practice should be based on existing evidence, relevant expert consensus, and the use of available resources. Greater attention should be given to the treatment of wounds with a predicted healing time exceeding 20 d (strongly recommended) (evidence level: moderate)
Selection of topical anti-scar agents for children	Silicone-based agents are recommended after wound epithelialization for >12 h per day until scar maturation (high-level evidence). For established scars, the topical application of silicone gel is recommended to soften the scars and alleviate itching, pain, and redness (moderate-level evidence). For well-healed wounds, silicone gel sheets/tapes are prioritized for preventing scar hypertrophy. If the newly formed skin is thin and fragile, silicone gel may be used initially, with gradual transition to silicone gel sheets/tape based on wound condition (strongly recommended) (evidence level: moderate). Topical application of medications containing onion extract on the scar surface twice daily for at least 28 d is recommended to improve scar thickness, redness, itching, hyperpigmentation, and pain (moderately recommended)(evidence level: moderate)
Pressure therapy for pediatric scars	Pressure therapy is recommended to commence as soon as wound epithelialization is complete. Pressure should be maintained in the range of 2.00‒5.33 kPa with a daily treatment duration of at least 23 h (strongly recommended) (evidence level: moderate) The advent of affordable 3D scanning and printing has been an important recent development allowing for tailor-made solutions. Transparent masks produced via 3D scanning and printing are recommended for pediatric facial scar prevention and treatment and can be combined with silicone to increase pressure in specific areas and protect the skin, reducing the impact on the growth and development of facial bones and teeth (moderately recommended) (evidence level: low). Combining pressure therapy with silicone-based medications or laser therapy for wounds that have achieved re-epithelialization is recommended (strongly recommended) (evidence level: moderate)
Medication injection treatment for pediatric scars	For small pediatric scars associated with significant itching and pain, intralesional injection therapy with glucocorticoid steroids is recommended. Treatment dosage should be individualized based on scar thickness, area, and severity. A single dose of triamcinolone acetonide ranges from 10 to 40 mg, with injection intervals of 1 to 4 weeks. Empirically, a course of 4‒8 injections is recommended, and the total monthly dose should not exceed 40 mg; dosing per kilogram body weight may be more appropriate. Subsequent treatments should be adjusted according to the therapeutic response until the scar becomes flattened and softened or no further improvement is observed (moderately recommended) (evidence level: moderate)
Laser therapy for pediatric scars	Laser therapy is recommended to be initiated at 1‒2 weeks after traumatic wound healing, 2 weeks after burn healing, and 2‒4 weeks after skin grafting (moderately recommended) (evidence level: low) . The use of pulsed-dye laser (PDL), intense pulsed light (IPL), or fractional CO₂ laser for the prevention of scar hypertrophy is recommended (moderately recommended) (evidence level: low). For children with thickened scars accompanied by pain and itching, low-energy fractional CO₂ laser treatment is recommended (strongly recommended) (evidence level: high). For pediatric hypertrophic scars accompanied by pruritus, pain, or significant thickening, a treatment regimen combining a fractional CO₂ laser with topical drug delivery is recommended (evidence level: low). PDL combined with fractional CO₂ lasers or compression therapy is also recommended to reduce scar erythema, improve thickness, and modulate biomechanical properties (moderately recommended) (evidence level: high). An ablative fractional laser is recommended as the primary option for treating mild scar contracture in children. The appropriate laser energy should be selected based on the thickness of the scar. PDL can also be used in combination (moderately recommended) (evidence level: moderate). Combining laser therapy with functional exercise and rehabilitation for pediatric scar contractures is recommended (weakly recommended) (evidence level: very low). The use of local anesthetics or cold sprays during laser therapy for pain management is recommended (moderately recommended) (evidence level: moderate)
Surgical treatment of pediatric scars	When scars limit functional activity, lead to recurrent ulceration, or risk affecting growth or causing cosmetic damage, surgical intervention is recommended if non-surgical therapies are ineffective (strongly recommended) (evidence level: low)
Rehabilitation training in the prevention and treatment of pediatric scars	It is recommended to adopt a rehabilitation philosophy of “early intervention, comprehensive management, and continuous follow-up” by implementing an integrated scar rehabilitation program that incorporates kinesiotherapy, scar massage, and play therapy as early as possible (moderately recommended) (evidence level: low). It is recommended that rehabilitation therapy, including exercise and scar massage, be conducted under the guidance of a therapist in a healthcare facility or at home. When scar massage is performed, ample pressure should be applied to improve tissue elasticity and pliability (moderately recommended) (evidence level: very low)
Psychotherapy in the prevention and treatment of pediatric scars	It is recommended that medical staff closely monitor the psychological state of children using objective measurement tools where possible (moderately recommended) (evidence level: very low)
Family support in the prevention and treatment of pediatric scars	It is recommended that healthcare providers and patients use digital health platforms, such as online hospital systems and WeChat, to establish a regular communication mechanism for children undergoing scar rehabilitation at home to provide timely and tailored guidance (moderately recommended) (evidence level: moderate)
Assessment of the treatment outcomes for pediatric scars	It is recommended that the VSS and POSAS be used to evaluate pediatric scar treatment outcomes, supplemented by objective measurement tools (moderately recommended) (evidence level: very low)

Recommendation	Interpretation
Wound factors in scar prevention and treatment for children	Given the correlation between wound healing time and the incidence of hypertrophic scars, systematic wound management aimed at promoting wound healing should be prioritized as the primary method for scar prevention and treatment. Practice should be based on existing evidence, relevant expert consensus, and the use of available resources. Greater attention should be given to the treatment of wounds with a predicted healing time exceeding 20 d (strongly recommended) (evidence level: moderate)
Selection of topical anti-scar agents for children	Silicone-based agents are recommended after wound epithelialization for >12 h per day until scar maturation (high-level evidence). For established scars, the topical application of silicone gel is recommended to soften the scars and alleviate itching, pain, and redness (moderate-level evidence). For well-healed wounds, silicone gel sheets/tapes are prioritized for preventing scar hypertrophy. If the newly formed skin is thin and fragile, silicone gel may be used initially, with gradual transition to silicone gel sheets/tape based on wound condition (strongly recommended) (evidence level: moderate). Topical application of medications containing onion extract on the scar surface twice daily for at least 28 d is recommended to improve scar thickness, redness, itching, hyperpigmentation, and pain (moderately recommended)(evidence level: moderate)
Pressure therapy for pediatric scars	Pressure therapy is recommended to commence as soon as wound epithelialization is complete. Pressure should be maintained in the range of 2.00‒5.33 kPa with a daily treatment duration of at least 23 h (strongly recommended) (evidence level: moderate) The advent of affordable 3D scanning and printing has been an important recent development allowing for tailor-made solutions. Transparent masks produced via 3D scanning and printing are recommended for pediatric facial scar prevention and treatment and can be combined with silicone to increase pressure in specific areas and protect the skin, reducing the impact on the growth and development of facial bones and teeth (moderately recommended) (evidence level: low). Combining pressure therapy with silicone-based medications or laser therapy for wounds that have achieved re-epithelialization is recommended (strongly recommended) (evidence level: moderate)
Medication injection treatment for pediatric scars	For small pediatric scars associated with significant itching and pain, intralesional injection therapy with glucocorticoid steroids is recommended. Treatment dosage should be individualized based on scar thickness, area, and severity. A single dose of triamcinolone acetonide ranges from 10 to 40 mg, with injection intervals of 1 to 4 weeks. Empirically, a course of 4‒8 injections is recommended, and the total monthly dose should not exceed 40 mg; dosing per kilogram body weight may be more appropriate. Subsequent treatments should be adjusted according to the therapeutic response until the scar becomes flattened and softened or no further improvement is observed (moderately recommended) (evidence level: moderate)
Laser therapy for pediatric scars	Laser therapy is recommended to be initiated at 1‒2 weeks after traumatic wound healing, 2 weeks after burn healing, and 2‒4 weeks after skin grafting (moderately recommended) (evidence level: low) . The use of pulsed-dye laser (PDL), intense pulsed light (IPL), or fractional CO₂ laser for the prevention of scar hypertrophy is recommended (moderately recommended) (evidence level: low). For children with thickened scars accompanied by pain and itching, low-energy fractional CO₂ laser treatment is recommended (strongly recommended) (evidence level: high). For pediatric hypertrophic scars accompanied by pruritus, pain, or significant thickening, a treatment regimen combining a fractional CO₂ laser with topical drug delivery is recommended (evidence level: low). PDL combined with fractional CO₂ lasers or compression therapy is also recommended to reduce scar erythema, improve thickness, and modulate biomechanical properties (moderately recommended) (evidence level: high). An ablative fractional laser is recommended as the primary option for treating mild scar contracture in children. The appropriate laser energy should be selected based on the thickness of the scar. PDL can also be used in combination (moderately recommended) (evidence level: moderate). Combining laser therapy with functional exercise and rehabilitation for pediatric scar contractures is recommended (weakly recommended) (evidence level: very low). The use of local anesthetics or cold sprays during laser therapy for pain management is recommended (moderately recommended) (evidence level: moderate)
Surgical treatment of pediatric scars	When scars limit functional activity, lead to recurrent ulceration, or risk affecting growth or causing cosmetic damage, surgical intervention is recommended if non-surgical therapies are ineffective (strongly recommended) (evidence level: low)
Rehabilitation training in the prevention and treatment of pediatric scars	It is recommended to adopt a rehabilitation philosophy of “early intervention, comprehensive management, and continuous follow-up” by implementing an integrated scar rehabilitation program that incorporates kinesiotherapy, scar massage, and play therapy as early as possible (moderately recommended) (evidence level: low). It is recommended that rehabilitation therapy, including exercise and scar massage, be conducted under the guidance of a therapist in a healthcare facility or at home. When scar massage is performed, ample pressure should be applied to improve tissue elasticity and pliability (moderately recommended) (evidence level: very low)
Psychotherapy in the prevention and treatment of pediatric scars	It is recommended that medical staff closely monitor the psychological state of children using objective measurement tools where possible (moderately recommended) (evidence level: very low)
Family support in the prevention and treatment of pediatric scars	It is recommended that healthcare providers and patients use digital health platforms, such as online hospital systems and WeChat, to establish a regular communication mechanism for children undergoing scar rehabilitation at home to provide timely and tailored guidance (moderately recommended) (evidence level: moderate)
Assessment of the treatment outcomes for pediatric scars	It is recommended that the VSS and POSAS be used to evaluate pediatric scar treatment outcomes, supplemented by objective measurement tools (moderately recommended) (evidence level: very low)