Treating Scars. What Really Helps?

Scars are a completely normal consequence of skin injury. Almost every person in the world has at least one scar. However, scars can be physically and psychologically distressing for some patients.

Thankfully, many good treatment options are available to lessen the appearance of scars. There are also precautions you can take to ensure your wound will heal as nicely as possible.

What is a scar?

Scars are the body's natural response to healing any injury to the skin, such as surgery, cuts, or burns. Scarring is a normal, biologically-determined process that occurs in all healing wounds. It occurs in the final stages of wound healing when collagen is produced and remodeled to close the wound.

What factors control the appearance of a scar?

Several factors, relating to the injury and the patient, control the outcome of the scar. The characteristics of the injury that dictate the degree of scarring include the type, depth, size, and location. Certain injuries, such as traumatic injuries and burn scars, heal worse than surgical scars. The deeper and larger the injury, the worse it heals. Also, lower legs and feet heal the worst and slowest because of poor circulation. Finally, improper wound care for the injury can also worsen a scar.

Characteristics of the patient, such as age, genetics, ethnicity, medications, and medical conditions, will dictate the scar's final appearance. Older patients do not heal as well as younger patients do. Some patients are genetically prone to poor healing and worse scarring. Darker skin types are more prone to keloid scarring. Also, patients who are malnourished or immunosuppressed because of certain medications, such as prednisone, or medical conditions, such as cancer, heal worse.

What are the different types of scars?

Flat scars begin as linear, pink, slightly raised scars, that flatten and turn white with time. They usually result from surgical excisions or minor cuts. These scars respond well and are the easiest to treat.

Hypertrophic scars and keloids are raised scars that result from excessive collagen production during the healing phase. They commonly appear on the trunk and upper arms. The difference between hypertrophic scars and keloids is that keloids are large, extend beyond the original wound, and do not resolve without treatment.

Sunken scars also referred to as atrophic scars or depressed scars, often occur from acne, chickenpox, or shingles. These scars result from inflammation from the underlying process. There are several types of depressed acne scars, including boxcar, icepicks, or rolling scars.

Contracted scars appear mostly after burns. They occur after the tissue heals, and the skin becomes tighter and thicker, impeding movement. These can commonly occur over joints.

What are treatment options?

There are various treatment options for scars, many of which are specific to the type of scar. They range from non-invasive to invasive. These treatments are used after the wound has healed. While they can improve the appearance of scars, no treatment removes them completely.

Non-invasive treatment options for scars include silicone gel, silicone sheets, prescription topicals, steroid tape, over-the-counter topicals, pressure dressings, and camouflage creams. For minor scars, these options are great first-line treatments. There is very little chance of any adverse side effects from these treatments. Silicone gel or sheets apply pressure to the scar to flatten and soften it. They are used daily for many months. Some use them under pressure bandages for better results.

Prescription creams, such as retinoids or steroids, help improve scars. It takes many months of consistent daily usage to see improvement. Steroid tape, also by prescription, is another option to treat raised scars. You cut the tape to the size of the scar and apply it for 12 hours every day. It can also take months to improve the scar.

There are several over-the-counter scar creams on the market, such as Mederma, which can help. They must be massaged into the scar several times a day for several months to see improvement. Many other over-the-counter options, such as coconut oil, aloe vera, honey, or vitamin E may help, but there is a lack of good studies to support these claims. Finally, camouflage cream, which is thick makeup, is applied during the day to mask the scar.

There are several minimally invasive scar treatment options, such as steroid or 5 FU injections, lasers, fillers, chemical peels, subcision, micro-needling, and cryotherapy.

Steroid and 5 FU injections can flatten raised scars, such as hypertrophic scars and keloids. It could take more than one treatment. Thinning skin (atrophy) is a possible side effect of steroids, so they are often combined with 5 FU injections to reduce side effects and enhance the scar treatment.

Cryotherapy, which involves applying cold liquid to destroy scar tissue, can also improve raised scars with multiple treatments.

Fillers and subcision can help sunken scars, especially acne scars. Fillers are substances, such as hyaluronic acid, that are injected into the scars to plump them up. Depending on the filler, it will need to be re-treated in 6–12 months. With subcision, a needle is inserted under depressed scars to break up the scar tissue underneath, release it, and allow the tissue to pop back up and become flush with the surrounding skin.

Lasers, micro-needling, and chemical peels help improve the appearance of mild scarring after several treatments.

Lasers, such as pulsed dye lasers and intense pulsed light devices, can be used to lighten scars and remove redness. Resurfacing lasers can improve the texture and camouflage the scar, but they are more invasive and require healing time.

Microneedling involves using a device with numerous tiny needles to cause microdamage to the skin, leading to new collagen formation and subsequent improvement in the scar.

Peels can remove layers of scar tissue to improve the appearance of the scar.

Invasive scar treatments, like surgery and radiation, are reserved for scars that have failed to respond to other treatments. This is because they carry the worst side effects. Surgery, which can treat any scar type, could potentially worsen scars. Radiation, which can treat keloids, has been linked to the development of cancers in the future.

How to prevent scars?

Scars appear as a result of skin healing from an injury. You cannot completely prevent the appearance of scars unless you avoid injury. However, you can minimize the risk of scarring by taking simple precautions:

• Keep the wound clean.
• Keep it moist with antibiotic ointment or vaseline petroleum jelly.
• Avoid irritation to the wound by keeping it covered and protected with a clean bandage.
• Once the wound heals, keep it covered and protected from the sun with UPF clothing or sunscreen.

Scars are a normal part of wound healing. Any injury to the skin can result in scar formation. It is vital to prevent scars by proper care of your wounds. If a scar forms, there are several different treatment options available, so it is best to consult a board-certified dermatologist or plastic surgeon to find the treatment that is right for you.