Scarring – an under-managed problem:
- A scar is made of collagen fibres and is an essential part of the natural healing process following an injury to the thick layer of the skin (dermis).
- Scars look and feel different from normal skin because they have a different composition, structure and function.
- The appearance of scars is numerous: Each year in the developed world 100 million patients acquire scars, some of which cause considerable problems, as a result of 55 million elective operations and 25 million operations after trauma.1 There are an estimated 11 million keloid scars and four million burn scars, 70% of which occur in children. Global figures are unknown but doubtless much higher.[1]
“Abnormal scars can cause unpleasant symptoms and can be aesthetically distressing, disfiguring and psychosocially and functionally disabling.” [1]
- Hypertrophic scars can be “especially severe in children”, causing “much functional, cosmetic and psychological morbidity.” [2]
2002 International Clinical Recommendations on Scar Management – only Silicone Gel and intralesional steroids have sufficient clinical evidence to be endorsed by scar experts. [3]
The human impact of scars
A scar may appear redder and thicker at first, and then gradually fade – but not all scars fade away as quickly as we would like and some become abnormal.
Abnormal scars:
- Grow bigger
- Remain red/dark and raised without fading
- Cause discomfort, itching or pain
- Restrict the movement of a joint
- Cause distress because of appearance
Types of scars
Hypertrophic scars
Scars are raised scars that remain within the boundaries of the original lesion, generally regressing spontaneously after the initial injury. Hypertrophic scars are often red, inflamed, itchy, and even painful. They typically occur after burn injury on the trunk and extremities. [4]
Keloid scars
Are raised scars that spread beyond the margins of the original wound and invade the surrounding normal skin in a way that is site specific. Ear lobe keloids often grow as large lobules, central sternal keloids commonly develop a butterfly shape, and deltoid keloids tend to extend vertically. A keloid continues to grow over time, does not regress spontaneously, and almost invariably recurs after simple excision. It is difficult to apply the term keloid until a scar has been present for at least a year, although there is no precise time interval. [4]
New scars
Scar prevention measures can be taken once the wound has closed and the skin is unbroken.
Atrophic scars
Are flat and depressed below the surrounding skin. They are generally small and often round with an indented or inverted centre, and commonly arise after acne or chickenpox. [4] These scars may require a different treatment and it is recommended that you consult a dermatologist.
What options are available?
Currently available therapy options for scar treatment/prevention include:
Non-Invasive
- Silicone gel sheeting, e.g. Dermatix®
- Pressure/compression therapy
- Topical steroids
- Counselling
- Polyurethane patches
Invasive
- Surgery
- Injected steroids
- Radiotherapy
- Cryotherapy
- Laser therapy
Other treatments (no medical evidence)
- Topical vitamin E cream (and other moisturisers)
- Plant extract creams
- Massage therapy
- No treatment
