The skin consists of the epidermis and the dermis. The dermis is the deeper of the two layers and any injury here be it traumatic or surgical will result in scarring. New scars are usually red and can be raised. Over a period of 12 months, the scar matures, flattens and loses its redness. Occasionally ‘bad’ scars can form which are lumpy, itchy and painful. There are two types of ‘bad’ scars that can form :
A keloid scar is a lumpy, red and itchy scar which can extend beyond the initial injury. It more commonly occurs in asian and afro-carribean skin although it can also occur in caucasian skin. They also occur more commonly in certain areas such as the central chest, the shoulders and the ears. Keloid scars are notoriously difficult to treat due to their propensity to recur.
A hypertrophic scar occurs more commonly than a keloid scar. They are usually red, lumpy and itchy too but do not extend beyond the initial injury. The majority of hypertrophic scars resolve conservatively over time however in some cases, they require treatment.
Treatment options :
Conservative management consists of scar massage and moisturising. This helps the scar to mature. The effectiveness of this treatment however is limited for hypertrophic or keloid scars.
Silicone tape / gel
Silicone tape or silicone gel can be effective when used on hypertrophic scars however they need to be used consistently over a minimum period of at least six months for any appreciable improvement
Intralesional steroid injection
Steroids can be injected into both keloid and hypertrophic scars to improve them. The injections usually need to be performed every 6-8weeks directly into the scar and a course of treatments typically consists of five injections
Lasers can be used to improve the appearance of scars. The CO2 laser can resurface scars, helping to flatten them and improve their appearance. The pulsed dye laser can be used to reduce the overall redness of scars
Surgical scar revision is usually reserved as a last resort, after all other methods have been tried. This is occasionally combined with intralesional steroid injections to reduce the recurrence of a ‘bad’ scar. The outcome of surgical scar revision however can be unpredictable with hypertrophic or keloid scars recurring soon after treatment