Scar Treatment

Scar Treatment


A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the normal biological process of wound healing. 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 regenerating skin cells on the wound surface. There is no defect in the skin continuity, and the skin accessory structures such as sweat glands, hair follicles, and sebum glands are intact. This type of healing does not cause scar formation.


On the other hand, the healings of deeper wounds invariably are associated with scar formation. The severity of the scar formation depends on wound severity and wound management. 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 active in the third to six months during wound healing. During this time, the scars typically appear red, elevated, and tense. This active phase will subside subsequently, and the scars become 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 produce massive scarring with skin function loss and significant skin appearance changes.


Excessive scar formation gives rise to hypertrophic scars and keloids. A hypertrophic scar is a widened, elevated scar confined within the wound boundaries and usually resembles a red lump on the skin. The hypertrophic scar usually reaches a specific size and subsequently stabilizes and regresses. Keloids are a more severe form of excessive 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. Wound locations. Hypertrophic scars and keloids commonly occur in the body areas 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.
  3. Wound closure. Wounds that are unrepaired result in excessive scarring compared to wounds that are repaired promptly and correctly.
  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. Keloids are more frequent in blacks and Asian populations.



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 the wound itchy during wound healing. Avoid scratching the wound to prevent causing injury to the skin and aggravating scarring.



Treatments of Scars

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

  1. Silicone sheets. Silicone sheets can be used after surgery 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. A piece of silicone sheet is reusable 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 decrease scarring 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 option 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 optimal results.
  7. Botulinum toxin A (Botoxâ). Botulinum toxin A can decrease the tissue tensile forces in the scars and reduce scarring.
  8. Surgical subcision: A treatment for a depressed scar.
  9. Scar revision surgery: scar revision is surgery 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.


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