Wound & Scar After Care Guidance By Dr Mark Brewin

7 Feb 2018

What is a scar?

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 and keloids are different. Hypertrophic scars keep within the area of the original wound, whereas keloids spread beyond
the wound borders. Hypertrophic scars generally appear within 4 weeks of the wound healing, whereas keloids appear generally at 3 months but may take up to several years to grow. Hypertrophic scars commonly flatten, pale and mature but this may take up to two to three years, whereas
keloids remain and are difficult to treat. Keloids are more common in darker skin types and they
are now thought of as an extreme form of hypertrophic scar. Abnormal scarring is more common for females and those patients of a young age.

Other factors that influence this type of scarringare where the wound is on the body, how bad the wound was and how long the wound took to heal. Scarring can sometimes limit your movement andthis is known as a contracture. Other types of scarring include stretch marks and acne scars.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 andpainful. Scars may affect your sleep or make you
anxious or depressed. Any of these symptoms may in turn disrupt your daily activities. Your quality of life may be also affected by post-traumatic stress, loss of self-esteem, and embarrassment in socialsituations. Some scars require further surgery and hospital visits.

What can I do to look after my scar?

Moisturising and Massage
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, non-perfumed, aqueous moisturiser that suits both your skin and your budget
There is no clinical evidence that expensive moisturisers are any more effective. www.mytrustyskincare.co.uk

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. Whitepimples, 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?

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. These products may be prescribed by
your doctor or nurse, but can also be purchased at a pharmacy.

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. There are two types of pressure garment:
‘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). These garments are not
cheap to buy but may be given to you if you are attending hospital for your scar, particularly if youhave had a burn.
Steroids
Steroid injections may be offered to you by your doctor. The steroid is injected into the scar to reduce any swelling, and acts to soften and flattenit. It may also help to decrease the itching, redness, and burning sensations. Steroid-impregnated tape can also be used to try to flatten keloid scars. This can be prescribed by a GP or dermatologist and is applied for 12 hours a day.

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 and you have limited movement where your scar is over a joint. You may have been given some exercises by your therapist at hospital. It is important that you do these regularly, especially if your scars are limiting
your movement. It may be necessary for you to be fitted with a splint to prevent tightening. You must wear this as directed, but if it doesn’t fit properly you should contact your therapist. “Skin camouflage” make-up. It may be possible to cover or disguise your scarring using professional make-up or “skin camouflage”. More information can be found at www.changingfaces.org.uk

Frequently asked Questions?
Why do scars change colour?
The healed skin may appear pink, dark pink, red or even purple. Changes in colour are a normal part of the scar process. Scars may also change colour
temporarily, for example if you become hot or cold. Over time, the colour of the scar will fade. Patches of brown around or in the scar can also occur and these will also fade.

Do I need to protect my scar from the sun?
Yes. You need to protect your newly healed skin from the sun. This is very important while your scars mature and this can take up to 2 – 3 years. You should wear a high factor sun cream (SPF 30 or greater and a star rating of 3 or more) that protects against UVB and UVA rays. You may want to cover up with clothing where possible and to avoid the sun during the middle of the day.

Why does my scar itch so much?
Firstly, try not to scratch your scar! On the plus side, itching may be seen as a normal part of the healing process. In part, this may be due to nerves, that were once damaged or cut, now growing back. It may also be due to some dryness or inflammation of the skin around the scar. Anti-histamine medication may help with the itch and can be bought at your local pharmacy. You could try keeping your moisturiser in the fridge as the cold cream will also soothe. If the itch persists, you should seek specialist scar advice for laser treatment,silicone gels or steroids.

Useful websites
www.talkhealthpartnership.com/talkscars
www.adultburnssupportuk.org
www.dansfundforburns.org
www.katiepiperfoundation.org.uk

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