Dr Roger Henderson recommends the best treatments for reducing scars and keloids.
By Dr Roger Henderson
Concerned about your scars? Essentially a mark left on the skin after a wound or an injury has healed, while scars are perfectly normal and we all have them, visible scarring can impact your self-esteem.
But what causes scars, what are the different types and can you minimise their appearance? We speak to family GP Dr Roger Henderson about the best treatments for scars and keloids:
What causes a scar to form?
Scars are very common and almost all of us have at least one on our bodies, usually following an accident or trauma to the skin.
Whenever trauma to the skin or a break in the tissues of the body occurs, our body responds by producing a protein called collagen that helps the healing process. This then builds up where the tissue has been damaged, helping to heal and strengthen the wound.
New collagen is produced for 8 to 12 weeks, and along with this the blood supply to the injured area increases, causing the scar to become raised, lumpy and red. As collagen then slowly starts to break down at the site of the wound, the blood supply reduces and the scar gradually becomes smoother, softer and paler.
Although scars leave a permanent mark, they can fade away almost to the point of being invisible. This can take up to two years – after this time, they do not usually fade any more. There are some parts of the body that tend to scar more than others, with the typical areas being the chest, back, ear lobes and shoulders.
The different types of scarring
There are four main scar types:
This is the usual type of scar most people have, it is a red, raised scar that forms along a wound and can remain unchanged for several years.
A much thicker and more pronounced type of scar, it is caused by excessive scar tissue developing at the site of the wound. This type of scar often grows beyond the original wound, even after the wound has healed. Patients with black or fair and freckled skin and red hair tend to produce keloid scars. On rare occasions, the skin in the middle in the chest can produce keloid scars spontaneously without any known injury.
- Pitted – ‘ice-pick’
These are small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object. Pitted scars are typically linked to severe acne.
Typically caused after a significant burn, these scars are due to the skin shrinking and tightening, and can significantly restrict movement in severe cases.
How should scars be treated?
The majority of hypertrophic scars need no formal treatment, since they eventually tend to mature and become pale. Although scars do not usually disappear completely, most will gradually fade over time and not be particularly noticeable.
To help reduce the risk of serious scarring, try the following:
✔️ Don’t pick at scabs or spots and cover any wounds with a waterproof ointment (such as Vaseline).
✔️ Using silicone gels or sheets can sometimes help to reduce redness and encourage healing. However, if scarring is unsightly, uncomfortable or restrictive, then treatment may be considered.
✔️ Using skin creams usually has little direct effect on a scar, but the massaging of a simple moisturiser into a scar can keep it from becoming dry.
✔️ Use a sunscreen on a scar since they can be sensitive to the effects of the sun.
These can be difficult to treat, and possible options include dermabrasion and chemical peels to reduce scar depth and tighten the skin.
This a modern option but no treatment actually removes the scars completely.
With burn scarring, deep burns tend to cause significant scars. The main treatment is with pressure garments, but silicone can be helpful and surgery can be undertaken to replace very severe scars with skin grafts and to help reduce skin tension in the scar.
Significant scarring treatment
Examples of treatment options for significant scarring include:
Typically made from stretchy material such as Lycra or Tubigrip, pressure is applied to the scarred area day and night for many months or even longer.
Applied directly to the wound, these can speed up maturation of a scar in some people.
Application of a steroid-containing tape, such as Haelan tape, which is worn day and night for extended periods. Occasionally, strong steroids such as triamcinolone can be injected into the scar itself and this is often considered with severe keloid scars.
Not done routinely, and then only by specialists, this is performed under a local anaesthetic if it is felt that a significant scar can be improved. The old scar is removed by one of several plastic surgery techniques and is repaired.