Volume 30, Issue 169, March 2026

Botulinum Toxin Type A and Other Non-Surgical Modalities in Hypertrophic and Keloid Scar Management: A Review of Clinical Evidence

Ewelina Roksana Wojna^1♦, Karolina Górowska¹, Aleksandra Korżel¹, Kamil Źródłowski¹, Patrycja Anita Kobrzyńska², Jędrzej Mogilany¹, Julia Niedźwiecka³, Gabriela Ragan³

¹Medical University of Lodz: Lodz, Łódź Voivodeship, Poland
²University Clinical Hospital No. 2 of the Medical University of Lodz: Łódź, ul. Stefana Żeromskiego 113, 90-549 Łódź, PL, Łódź, Poland
³Medical University of Lodz, Al. Tadeusza Kościuszki 4, 90-419 Łódź, Poland

^♦Corresponding author
Ewelina Roksana Wojna, Medical University of Lodz: Lodz, Łódź Voivodeship, Poland

ABSTRACT

Hypertrophic scars and keloids are one of the most challenging scars to treat, as their high rate of relapse, functional disability, and their psychosocial effects on patients make their management a formidable task. Various treatment options are available for treating hypertrophic scars, including corticosteroid injection, silicone treatment, pressure garments, and laser therapy. However, the results obtained with these techniques have been inconsistent. None of these treatment modalities has been proven as a gold standard. Growing evidence suggests that botulinum toxin type A (BTX-A) may play an important role in both preventing and treating pathological scarring. We decided to assess the clinical and experimental data of utmost importance regarding the role of BTX-A in the management of hypertrophic and keloid scarring. According to experimental research, BTX-A reduces neurogenic inflammation, alters fibroblast function, and lessens mechanical tension in wounds by inhibiting the P-neurokinin-1 receptor system. Clinical trials spanning a range of surgical and traumatic patient populations, such as thyroidectomy, facial wounds, blepharoplasty, mastectomy, and burn scars, have all consistently demonstrated enhanced scar height, pliability, erythema/skin redness, and pain, as well as an improvement in patients’ subjective assessment. Meta-analyses also show that BTXA is statistically more effective than placebo and other treatments. Differences in dose schedules and administration timing, as well as insufficient information on long-term effects, make these results impossible to be generalizable. In general, BTX-A appears to be a safe and effective complement to the multimodal, personalized treatment of hypertrophic and keloid scars.

Keywords: Botulinum Toxin Type A; Hypertrophic Scar; Keloid; Non-Surgical Treatment; Scar Management

Medical Science, 2026, 30, e59ms3814

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DOI: https://doi.org/10.54905/disssi.v30i169.e59ms3814

Published: 30 March 2026