Scarring is the process by which wounds are repaired. Damage in the deeper layer of the skin, the dermis, required to produce a scar. Damage only the epidermis, the most superficial layer of skin, will not produce a scar. Scar produces a structural change in the deeper layers of the skin which is perceived as an alteration in the architecture of the normal surface features. It’s not just a change in skin color.
How Does Scarring Happen?
Scarring is a natural part of the healing process after an injury. Its appearance and treatment depends on multiple factors.
The depth and size of the wound or cut and the location of the injury matters. So do your age, genes, sex, and ethnicity.
There are several types of scars including:
- Keloid scars. These scars are the result of an overly aggressive healing process. This scar extends beyond the original injury. As time passed, a keloid scar may hamper movement. Treatments like steroid injections, surgery to remove the scar, or silicone sheets to flatten the scar. Smaller keloids can be treated by using cryotherapy (freezing therapy using liquid nitrogen). Also, you can prevent keloid formation by using pressure treatment or gel pads with silicone when you’re injured. Keloid scars are most common among people with dark skin.
- Contracture scars. If your skin has been burned, then you may have a contracture scar. These scars tightens skin, which can impair your ability to move. Contracture scars may also go deeper, which affects muscles and nerves.
- Hypertrophic scars. This scar are raised, appears red that are similar to keloids but do not go beyond the boundary of the injury. Treatment includes steroid injections to reduce inflammation or silicone sheets, which to flatten the scar.
- Acne scars. If you’ve had severe skin acne, you probably have the scars to prove it. There are types of acne scars, ranging from the deep pits to scars that are angular or wavelike in appearance. Treatment options are depending on the type of acne scars you have.
Corticosteroid injections are used to treat keloid and hypertrophic scars. Multiple small injections are made into the scar to reduce any inflammation (swelling) and to flatten the scar. Depends on the type of scar, these may need to be repeated. Injections are usually given on three occasions at 4-6 week intervals to assess your body’s response. Sometimes the treatment may continue for several months if the scar is improving. This treatment cannot remove scars, but improves their appearance.
Silicone gels or sheets
Silicone gels or sheets are available from some pharmacies. They are used on healing skin (not open wounds) to reduce redness and try to minimise hypertrophic or keloid scars.
Silicone gels or sheets is effective if it should be placed over the scar for 12 hours a day, for at least three months.
You can ask your GP, dermatologist or a pharmacist for further advice about a range of silicone-based scar treatments.
Sometimes, surgery can improve the appearance of the scars. Surgery can be used to:
- change the positioning of the scar
- change the width or shape of the scar
- release a tight scar that is close to a joint, thus to improve movement
Be aware that having surgery on your scar will leave a new scar that will take up to two years to improve in appearance. If surgery is done to treat a hypertrophic scar, then there is a risk that scarring may be worse after the surgery.
Surgery alone is not advised for keloids as they tend to grow back larger. Keloid surgery is often combined with corticosteroid injections, this injected at the site of the removed scar immediately after the surgery. Some plastic surgeons also added other treatments, such as oral antibiotics and X-ray therapy to try and minimise recurrence of a keloid that has been surgically treated. Talk to your surgeon about this.
For some pitted scars, laser surgery (laser resurfacing) is used. This involves using a laser to remove the top layers of the skin, stimulating collagen production in the deeper layers to try to make the scar flatter.
The aim of pressure dressings is to flatten and soften scars. This is the most often used for large burn scars or after some skin grafts.
Pressure dressings are usually made from stretchy, elastic material. They are worn over the scar 24 hours a day, from around six to 12 months. They can also be used in combination with silicone gel sheeting to improve the appearance of scars over a long period of time.
Pressure dressings are usually used under the supervision of a specialist.
Cosmetic camouflage (make-up) can help cover up scars and can be particularly useful for scars in the face. Some are waterproof and can stay in place 2-3 days.
Camouflage make-up that is specially designed for covering up scars is available over the counter at pharmacies. Alternatively ask your GP for the advice.
Please note that camouflage colour testing (to get a good colour match for your skin type) can be a lengthy process, sometimes taking over an hour, and needs to be performed by somebody who is qualified.
- Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue.
- Dermal fillers are injections (often of a man-made acid) used to ‘plump up’ pitted scars. Treatments can be a bit expensive and the results are usually temporary. Repeated treatments are needed to maintain the effect.
- Skin needling, these involves rolling a small device covered in hundreds of tiny needles across the skin, is also reported to be helpful, but repeat treatments are often needed to achieve an effect and results vary considerably.