Scar Treatment

Scar Treatment

Scars result from the normal biological process of wound healing, where normal skin is replaced by fibrous tissue following an injury. Except for very minor and superficial injuries, every wound gives rise to some degree of scarring.

The healing of superficial wounds such as minor superficial scratching is by regeneration of skin cells on the wound surface. There is no defect in the skin continuity and the skin appendages such as sweat glands, hair follicles, and sebum glands are intact. This type of healing does not cause scar formation.

On the other hand, deeper wounds which involve disruption of the continuity and integrity of the skin is invariably heal with scar formation. The severity of the scar formation depends on the extent of the wound and how the wound is managed. Injuries that are promptly managed by cleansing and surgical closure (suturing) are associated with faster healing and less scarring. Wounds that are deep, contaminated, infected, or not promptly treated will result in abundant scar tissue formation. Once a scar forms, it will remain in the skin permanently.

Scar formation usually becomes most active in the third to six months following the initial injury. During this time, the scars typically appear red, elevated, and tense. This active phase will subside subsequently and the scars will become softer, thinner, and the colour lightens. A clean-cut wound that is repaired and closed properly produces a fine scar that is hardly noticeable. On the other hand, deep and extensive wounds that is not properly managed will produce abundant scarring that may significantly affect skin function and appearance.

Excessive scar formation gives rise to hypertrophic scars and keloids. A hypertrophic scar is an elevated scar that is confined within the wound boundaries which resembles a red lump on the skin. Hypertrophic scar usually reaches a certain size and then stabilises and subsequently may regress. Keloids are the more severe form of abnormal scarring, and they can grow beyond the boundaries of the original wound into a huge lump. Keloids have the clinical appearance of a raised exuberant growth and are frequently associated with itchiness and pain.

Risk Factors of hypertrophic scars and keloids:

1. 1. 1. Location of the wound. Hypertrophic scars and keloids commonly occur in the body areas that are subject to repeated stretching and tension, such as the shoulder and chest. On the other hand, hypertrophic scars and keloids rarely happen in the palm, sole, or eyelids.

      2. Infection. Wound infections cause excess scarring which can lead to hypertrophic scars and keloids.

      3. Wound closure. Wounds that are not managed and closed properly usually result in excessive scarring compared to wounds that are managed and repaired promptly and peoperly.

      4. Age. Hypertrophic scarring and keloids are more common in young patients.

      5. Genetic predisposition. Specific individuals and groups are more prone to keloids formation due to genetic makeup.

Prevention of Scars

Early wound closures and prevention of wound infection are essential measures that prevent excessive scarring. Other preventive measures include sun protection, maintain skin moisture by using moisturizer and silicone sheet, taping and splinting, massage and physiotherapy. It is normal to feel  itchy in the wound during wound healing. Avoid scratching the wound to prevent injury to the skin that can aggravate scarring.

Treatments of Scars

Once a scar is formed, it will never go away completely. However, many treatments are available that can reduce their size and change its appearance to become less noticeable. The best remedy to use depends on many factors, such as the size, location, duration, functional disability, aesthetic concerns, and patient preference and compliance.

1. 1. 1. Silicone sheets. Silicone sheets can be used  to improve scarring. They are applied on the scar throughout day and night, including during sleep. The patient can remove the silicone sheet during a shower and reapply it after that. Silicone sheet usually can last for several weeks with proper care.

      2. Scar Gel: Silicone gel provides a flexible and transparent layer of silicone on the scar. Patients can use silicone gel on the face and other visible areas that are not suitable for silicone sheets.

      3. Pressure garments. Pressure garments made of elastic material have been a mainstay of scar control for burn injuries.

      4. Massage. Massaging scar tissue can help to decrease scar build-up and reduce scar tissue tightness. First, apply vitamin E lotion or baby oil to the scar area. Then, use the thumb or fingers to firmly massage in a circular motion for 5 minutes, alternate between clockwise and anticlockwise movements. Repeat 2-3 times a day.

      5. Corticosteroid injections. Corticosteroids, such as triamcinolone acetonide, can treat hypertrophic scars and keloids effectively. Corticosteroid injections are effective in flattening hypertrophic scars and keloids with a high response rate. Multiple injections may be required to achieve satisfactory results.

      6. Laser therapies. Lasers are most often used as a non-invasive treatment to improve scar texture, contour, and hyperpigmentation. Lasers are usually combined with other treatment modalities such as occlusion/compression therapy or intralesional corticosteroid injection for better results.

      7. Botulinum toxin A (Botox™). Botulinum toxin A can decrease the tissue tensile forces in the scars and reduce scarring.

      8. Surgical subcision: Usually reserved for depressed scars.

      9. Scar revision surgery: scar revision is surgery  done to improve scar tissue and restore functional disability caused by the scar. Depending on the scar’s size and location, various techniques can be used, such as direct scar excision and closure, z-plasty, w-plasty, local flap, and tissue expander.