Pressure Therapy for Hypertrophic Scar Management

Pressure therapy involves the application of sustained mechanical compression—typically 15–25 mmHg—through custom-fitted garments or masks to hypertrophic scars arising from burns, trauma or surgery. By exerting uniform pressure, this approach aims to flatten raised tissue, normalise collagen alignment and reduce vascularity, thereby alleviating itch and improving pliability. Its global adoption underscores both clinical efficacy and cost-effectiveness, though optimal treatment duration, garment design and patient compliance remain areas of active refinement. Mechanistically, compression influences cellular behaviour via mechanotransduction, downregulating fibroblast proliferation and extracellular matrix synthesis and modulating signalling cascades such as PI3K-Akt, MAPK and Hippo. Integration with silicone sheeting, laser therapy and emerging technologies—such as three-dimensional printing and sensor-embedded devices—continues to enhance personalised scar care and expand practical applications in diverse healthcare settings.

Research from Nature Portfolio

A comprehensive meta-analysis of randomised trials confirmed that pressure garments delivering 15–25 mmHg significantly reduce hypertrophic scar thickness, hardness, redness and overall appearance scores compared with no or low pressure, while emphasising the need for larger, well-controlled studies to assess long-term safety and side effects. In parallel, transcriptomic profiling in a porcine scar model identified over 500 pressure-responsive genes associated with extracellular matrix-receptor interactions, focal adhesion assembly and PI3K-Akt and MAPK signalling pathways, providing a molecular basis for pressure-induced remodelling. A trial‐based economic evaluation in paediatric burn survivors compared three interventions—pressure garments, topical silicone gel and their combination—and found that although pressure therapy incurred higher direct costs, quality-adjusted life years were similar across groups, suggesting that silicone alone may offer comparable clinical benefit with lower resource demands.

Pressure Therapy for Hypertrophic Scar Management publication trend

The graph below shows the total number of articles in pressure therapy for hypertrophic scar management across all publications each year (not limited to Nature Index journals).

Technical terms

Pressure garment therapy: Application of sustained mechanical compression via custom-fitted garments or masks to modulate scar tissue formation.

Extracellular matrix: Network of collagen, proteoglycans and glycoproteins that provides structural support and biochemical signals to skin cells.

Mechanotransduction: Cellular process by which mechanical stimuli are converted into biochemical signals affecting gene expression and protein activity.

Yes-associated protein (YAP): Transcriptional regulator in the Hippo pathway that controls cell proliferation and apoptosis in response to mechanical cues.

References

1. The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis. Scientific Reports (2017).
2. RNA-seq-based analysis of the hypertrophic scarring with and without pressure therapy in a Bama minipig model. Scientific Reports (2018).
3. Cost-effectiveness of scar management post-burn: a trial-based economic evaluation of three intervention models. Scientific Reports (2022).
4. NRP1 transduces mechanical stress inhibition via LATS1/YAP in hypertrophic scars. Cell Death Discovery (2023).
5. Digital workflow for fabrication of bespoke facemask in burn rehabilitation with smartphone 3D scanner and desktop 3D printing: clinical case study. 3D Printing in Medicine (2022).
6. Preliminary Study on the Development of a Real-Time Pressure-Monitoring Facial Mask for Burn Rehabilitation. European Burn Journal (2025).