Scar types and treatment

Save your skin from scars…

By-Dr. M.v. Annalarasi

Editor-Dr. Bharti Raizada

December 30, 2017

“ Scars are tattoos with better stories”. The stories might be very interesting to hear, but the truth is that most of these stories are nevertheless based on some painful moments.

The most superficial injuries like superficial burns and abrasions will heal by epithelialization (formation of tissue over the wound), without any scar formation. But scars are inevitable in deeper injuries.  For many, scars aren’t too bad if they are found in a place easy to cover or are too small to be of any measurable significance.

Scar tissue

The scar formation rate depends on certain factors like the age of the individual, the site of the wound, the wound healing time, and also the skin tension.  Scars of the wounds on the trunk of younger patients, which may heal slowly probably due to infection, take longer to mature. Also, scars that have a lot of tension across them will take a longer time to mature than scars in older people and in thin-skinned areas, which heal rapidly. These scars have minimal tension across them. Surgical incisions that are made along the tension lines leave minimal and usually acceptable scars. These skin tension lines are where the maximum tension is found when the skin is in a relaxed position. The incisions made across these lines lead to the big, bad, and ugly scars.

There are many types of scars and the treatment mode for each of them is dependent on the factors mentioned above along with their types.

Some of the types and their treatment approaches are listed below.

Scar Treatment

Pigmentation altered:

Scars are mostly hyperpigmented and when they are present in the areas likely to be noticed, it is advisable to cover them up with cosmetic camouflage or tattoos!!( if possible).

Tattooed scars:

During the process of healing, the implantation of any foreign object like dirt or soot  can result in the formation of a tattooed scar, wherein the foreign object would be seen through the pigmentation of the scar. This type of scar can be prevented by taking adequate treatment steps in the beginning, with proper wound management by brushing off the foreign material from the abrasions. The treatment of these scars in the later stage is very difficult.

Hypertrophic Scars:

In some instances, some scars go through the process of formation or remodeling to be exact, longer than usual. Such scars become hypertrophic scars. These scars are red, raised, itchy and painful and finally become pale and mature. These scars most commonly occur in children and in wounds where the healing is delayed probably due to infection.

The occurrence of such a scar can be controlled by a quiet primary healing. But, even if the scar does occur, massage of the scar with moisturizing cream or the application of pressure to the scar can speed up the process of maturation. Scar revision surgery is usually done if the scars cross the skin tension lines or in the event of any wound healing complication. Otherwise, the revision is avoided as there are chances of the scars occurring again.

Keloid scars:

The major differentiating characteristic between a hypertrophic and a keloid scar is the lack of spontaneous resolution of the latter into a pale scar. There is an extreme growth of tissue beyond the boundaries of the original wound and it most commonly occurs in the Afro-Caribbean and oriental racial groups. It is surprising to note that they often occur in wounds that healed without any complication. The common locations of occurrence of this type of scar are the central chest, the back, shoulders, and the ear-lobes. It is difficult to treat this type of scar. Treatment options include the application of external pressure, injection with steroids (triamcinolone), surgical resection etc.. Yet, the most successful and documented method so far has been a combination of surgery and radiotherapy or cryotherapy.

Acne Scar Treatment:

This is one of the most common issues faced by teens and adults alike. The best approach towards avoidance is to prevent the formation of acne in the first place and follow the recommended diet and hygiene practices. But if the situation is already out of control, consult your dermatologist who might recommend a microdermabrasion, commonly known as the chemical peel. You can also ask him about other options like Fractional laser therapy and laser resurfacing.

Some more treatment modalities:

The options available are of course plentiful but no single method is considered safe or effective. Read on to find out some innovative inventions. But always consult your dermatologist to see if it’s a viable option for you.

  1. Compression by silicone gel sheeting: The anti- keloidal effect of silicone is believed to work by increasing the temperature, hydration and probably the oxygen tension of scar. No formal reports are available for this theory. But, this method has been in use since the early 1980s to treat hypertrophic burn scars with successful therapeutics effects to its advantage.
  2. Cordran tape: A surgical tape containing steroid (flurandrenolide), that has been known to soften the hypertrophic and keloid scars.
  3. Interferon therapy: The interferons by their antifibrotic action prevent the hypertrophic scar formation.
  4. Onion extracts: There are some products available, with this composition, over the counter without any prescription. Even though it was initially considered a placebo, some studies have shown a real correlation between the healing and these products. Safer to use on smaller scars!
  5. Topical vitamin E formulation: Vitamin E has also shown significant benefits in the treatment of scars and there are products available, over the counter, containing hydrocortisone, silicone and Vitamin E.

 

Always consult your dermatologist, even before buying the “over the counter” products. Your skin is safe as long as you keep it safe.

Scar types and Treatment
Scar types and Treatment

Read about benefits of vitamin E: https://www.samecondition.com/blog/vitamin-e-benefits-vitamin-e-foods/

References:

  1. Bailey & Love’s Short Practice of Surgery Book by Henry Hamilton Bailey
  2. Shmerling, R. (2014). Leaving a mark — how and why we scar. In Harvard Health Publications (Ed.), Harvard Medical School commentaries on health. Boston, MA: Harvard Health Publications
  3. Scarless Wound Healing by A. David Rodrigues, and Michael T. Longaker.
  4. Ethnic Dermatology principles and practice Edited by Ophelia E. Dadzie, Antoine Petit, and Andrew F. Alexis.