Scar and Keloid

What Scars?

Scars are a natural part of the healing process. Most will fade and become paler over time, although they never completely disappear.

Types of scars

A scar can be a fine line or a pitted hole on the skin, or an abnormal overgrowth of tissue.

Normal fine-line scars

A minor wound like a cut will usually heal to leave a red, raised line, which will gradually get paler and flatter over time.

This process can take up to two years. The scar won’t disappear completely and you’ll be left with a visible mark or line.

Fine-line scars are common following a wound or after surgery. They aren’t usually painful, but they may be itchy for a few months.

On darker skin types, the scar tissue may fade to leave a brown or white mark. A pale scar may be more obvious on tanned skin because scar tissue doesn’t tan.

Keloid scars

A keloid scar is an overgrowth of tissue that occurs when too much collagen is produced at the site of the wound.

The scar keeps growing, even after the wound has healed.

Keloid scars are raised above the skin and are red or purple when newly formed, before gradually becoming paler. They’re often itchy or painful, and can restrict movement if they’re tight and near a joint.

Hypertrophic scars

Like keloid scars, hypertrophic scars are the result of excess collagen being produced at the site of a wound.

But not as much collagen is produced in hypertrophic scars compared with keloid scars.

Also, unlike keloid scars, hypertrophic scars don’t extend beyond the boundary of the original wound, but they may continue to thicken for up to six months.

Hypertrophic scars are red and raised to start with, before becoming flatter and paler over the course of several years.

Scar contractures

Scar contractures are often caused by burns.

They occur when the skin “shrinks”, leading to tightness and a restriction in movement.

Treatment

Treatment options for pressure ulcers (sores) typically include regularly changing your position, using special mattresses to reduce or relieve pressure, and dressings to help heal the ulcer. In some cases, surgery may be needed. Complete scar removal isn’t possible, but most scars will gradually fade and become paler over time.

A number of treatments are available that may improve a scar’s appearance and help make it less visible.

If scarring is unsightly, uncomfortable or restrictive, treatment options may include:

Silicone band or silicone gel sheets

Silicone gels or sheets can be used on healing skin (not open wounds) to help soften and flatten a scar. They can also relieve itching and discomfort.

To be effective, silicone gels or sheets should be placed over the scar for 12 hours a day for at least three months. They can be washed and reused.

Ask your doctor, dermatologist or pharmacist if they can recommend a suitable silicone-based scar treatment for you.

Pressure dressings/garments

Pressure dressings/garments are usually used under specialist supervision for treating large burn scars or after skin grafts. The aim is to flatten and soften the scars.

Pressure dressings/garments are usually made from a stretchy, elastic material. They’re worn over the scar 24 hours a day for around 6 to 12 months. They can also be used with silicone gel sheeting to improve the appearance of scars over a long period of time.

Steroids

Steroids can’t remove scars completely, but they can improve their appearance.

Corticosteroid injections can be used to treat some keloid and hypertrophic scars.

The scar is injected a number of times to reduce any swelling and flatten it. Depending on the type of scar, the injections may need to be repeated.

Injections are usually given on three occasions, four to six weeks apart, to assess your body’s response. Treatment may continue for several months if the scar is improving.

Steroid-impregnated tape can also be used to try to flatten keloid scars. It can be prescribed by a dermatologist and is applied for 12 hours a day.

Laser therapy

Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue.

For some pitted scars, laser surgery (laser resurfacing) is used to try to make the scar flatter. This involves using a laser to remove the top layers of skin, which stimulates collagen production in the deeper layers.

But there aren’t many long-term studies to prove the effectiveness and safety of laser therapy. If you have laser therapy, make sure the person doing it is a fully trained medical practitioner with experience in improving scars. Surgery