Scarring is an essential part of the wound healing process that happens after surgery, burns, or trauma, as the body attempts to restore the skin barrier. Scars commonly mature into flat and pale scars. However, they can behave abnormally when they become hypertrophic scars or keloids. These scars are red, raised, and firm.
Hypertrophic scars
Hypertrophic scars remain within the area of the original wound, generally appearing within 4 weeks of the wound healing. These commonly appear flat, and pale and will mature over time, but this may take up to two to three years.
Keloid scars
A keloid scar will spread beyond the wound borders, generally appearing after 3 months but may take up to several years to grow. Keloids are more difficult to treat and are more common in darker skin types, these are now thought of as an extreme form of hypertrophic scar.
What causes abnormal scarring?
Abnormal scarring is more common for females and those patients of a young age. It will also depend on where the wound is on the body, how bad the wound was, and how long the wound took to heal.
Scars are often thought of as trivial, but they can be debilitating, disfiguring, and unpleasant to look at for the patient. They can be itchy, tender, and painful. Scars may make you anxious, depressed, and lose sleep. Your quality of life may also be affected by post-traumatic stress, loss of self-esteem, and embarrassment in social situations. Some scars require further surgery and hospital visits.
What can I do to look after my scar?
The most basic thing that one can do to look after newly healing skin, or scar tissue, is to regularly moisturise the area in order to keep it hydrated. This may help to improve both the look and quality of your skin. You should use a simple, aqueous moisturiser that suits both your skin and your budget. There is no clinical evidence that expensive moisturisers are any more effective.
Once the healing skin is no longer fragile and less red, gently massage the moisturiser into the area up to 2-3 times a day for a few minutes. This may help loosen the scar tissue and make the skin more supple. If the scar is becoming firm, massage may involve medium to firm pressure in small circular movements over the area. It is very important that the skin is cleansed in between moisturising as a build-up of cream can cause skin irritation. White pimples, or blocked pores, may be seen.
You should try to wear loose clothing as clothing can rub and dry out the skin. When you take baths and showers, keep it warm, not hot, as hot water may remove the fatty substances in the skin that help it to hold moisture.
What treatments may be suitable?
Pressure garments
These are specialised, tight-fitting garments which put pressure on the scars. If used right, they may reduce the thickness and/or hardness of your scars. They can be made with inserted silicone pads to help to further improve the appearance of the scar.
‘Off the shelf’ garments are used when the scar remains delicate and tailored garments which are made according to your exact measurements. For best results, patients should wear their pressure garments for 23 hours per day (only remove them when you are washing).
Silicone gel or silicone sheeting
Silicone treatments are commonly used to improve the look of young scars. The silicone is not an active ingredient but it helps to lock in any moisture. This, in turn, helps to soften and smooth the area and, in some cases, may relieve pain and itch. Silicone gel is applied in a thin layer over the scar 2-3 times a day about 10 minutes after moisturising. Silicone sheets can be applied over the scar and left in place.
Laser treatment
Laser treatment can help both the symptoms and the look of your scar. Research has shown that pulsed dye laser can be used to reduce redness and itch of scars. Other lasers, such as the carbon dioxide laser, may be used to reduce the size of the scar, make it more supple or to improve the texture of the scarring. For more information, go to www.salisburylaserclinic.org.uk
Exercises and splinting
Scar tissue is stiffer than normal skin. You may notice that some areas feel tight with limited movement where your scar is over a joint. It may be necessary for you to be fitted with a splint to prevent tightening.
Frequently asked questions
For more information, visit our FAQ page
Useful websites
www.talkhealthpartnership.com/talkscars
www.adultburnssupportuk.org
www.dansfundforburns.org
www.katiepiperfoundation.org.uk
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