WHAT ARE SCARS?
Scars are areas of collagen deposition that replace normal skin after injury. A scar results from the biological process of wound healing. Scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease or surgery) results in some degree of scarring.
WHAT ARE HYPERTROPHIC SCARS?
- Develop soon after surgery
- Usually improve with time
- Remain within the confines of the wound
- Improve with appropriate surgery
- High incidence
- Have no association with skin color
WHAT ARE KELOIDS?
Keloid is a hypertrophic scar that extends beyond the limits of the original surgery. Keloids have the following clinical features1:
- May develop months after the trauma
- Rarely improve with time
- Spread outside the boundaries of the initial lesion
- Are often worsened by surgery
- Less frequent
- Are associated with dark skin color
ARE THERE ANY RISK FACTORS RESPONSIBLE FOR ABNORMAL SCAR FORMATION?
Yes. Age, skin type, genetic factors, location of the trauma, and hormones, are high risk factors responsible for abnormal scar development.
FROM WOUND TO SCAR. HOW DO I MINIMIZE THE INCIDENCE OF ABNORMAL SCARRING?
It is important to remember that a wound does not become a scar until the skin has completely healed. Until that point it is essential to look after your scar. A clean, warm, moist environment should be maintained, and movement should be restricted, in order not to place tension on the wound or surgery scar.
Four important factors, should be respected, in order to achieve the best scar outcome. Additionally, consultation should be sought from your healthcare professional should you have any concerns.
- Sun exposure: Scars, in particular new scars, should not be exposed to UV light and extreme temperatures (intense sunshine, sunbeds, saunas and extreme cold).
- Chemicals: Scars can be particularly sensitive to chemical ingredients to those contained in detergents, perfumes, herbal or botanical extracts.
- Clothing: Tight clothing should also be avoided, in order to prevent irritation and further injuring the scar tissue.
- Physical activities: Exercises or activities that cause tension on your scar should be avoided so your scar may heal without further disruption.
DO ALL TREATMENT OPTIONS WORK?
The literature is extensive, on the prevention and management of scars. However, the evidence, until recent years, was not strong on the best treatments for scarring.
In 2002, an International Advisory Panel on Scar Management published clinical recommendations on scar management based on 300 published references. Silicone was recommended as first line therapy for prevention of scarring, and first line treatment for the initial management of scarring .
HOW DOES SILICON WORK?
- Normal skin with mature stratum corneum and minimal transepidermal water loss (TEWL).
Partial or full-thickness injury.
At 1 to 2 weeks after wound- ing, reepithelialization is completed, but the stratum corneum is immature and allows abnormally high levels of TEWL. Dehydration of the stratum corneum is signaled (blue arrows) to keratinocytes, perhaps via an osmotic gradient.
Keratinocytes are stimulated to produce cytokines (red arrows), which in epidermal-dermal
signaling activate dermal fibroblasts to synthesize and release collagen. Excessive collagen production leads to abnormal scarring.
Treatment of the reepithelialized wound or the scar with silicone gel restores the barrier function of the stratum corneum, reducing TEWL and turning off the stimulation of keratinocytes. Keratinocytes stop producing cytokines that activate dermal fibroblasts.
After 2 to 3 months of silicone gel treatment, collagen deposition has normalized, and there is no scar hypertrophy.
RECOMMENDATIONS FOR THE PREVENTION AND TREATMENT OF SCARS
- Treatment should be initiated as soon as possible after surgical suture to prevent from an early stage the abnormal development of the scar tissue.
- Apply treatment directly to the scar, do not combine with other products except at the advice of the treating physician.
- Do not expose yourself to the sun in the first months after surgery, there is a risk that the scar may be pigmented.
- Use the treatment recommended by your doctor, daily, for at least 2 months, when the incidence of abnormal scars is higher.
- If you have a personal history of keloid scars, use the treatment for 9-12 months until the scar becomes mature.
- Wolfram D et al. Dermatol Surg 2009; 35:171–181
- Mustoe TA et al. Plast Reconstr Surg 2002; 110:560–571
- Mustoe TA. Aesth Plast Surg 2008; 32:82–92