Non-invasive objective tools for quantitative assessment of skin scarring

Significance: Multiple treatment modalities are utilised in the management of skin scarring, however, due to high recurrence rates and unknown resolution rates it can be difficult to assess if treatment is suitable or effective for the individual patient in particular in the case of raised dermal scarring. Therefore, it is necessary to evaluate these treatments and provide accurate scar assessment pre- & post-therapy in order to quantify scar characteristics using objective assessment tools, particularly non-invasive devices. Recent Advances: There have been a number of emerging non-invasive objective quantitative devices which assess specific scar parameters such as pliability, firmness, volume, colour, perfusion and depth. These can include 3-dimensional imaging, optical coherence tomography, in vivo confocal microscopy, full-field laser perfusion imaging and spectrophotometric intracutaneous analysis. Critical Issues: Clinical assessment and grading scales are most commonly used to assess scarring, however, there is a need for more objective quantitative measures to monitor their maturation and response to therapy. Currently, there is no consensus as to which objective measuring device is most optimal when assessing skin scarring. There is a need for a predictor tool which allows early implementation of treatment and addresses diagnosis, therapy and prognosis. Future Directions: Future technological advances and further validation of non-invasive objective scar assessment tools is essential. At present there is a greater emphasis on tools to assess the physical scar parameters rather than the physiological characteristics. Therefore, it is essential to develop a tool which measures the metabolic and cellular activity in scars in order to tailor treatment to each individual.