Scar Assesment & Scar management

Accurate scar assessment is essential for diagnosis and for starting, monitoring, and evaluating a therapeutic strategy for scar management. The cause and course of scar development are important-is the scar getting better or worse? A decision whether to treat will depend on:

1. Site (anatomical location of the scar)

2. Symptoms (pain, itching, etc)

3. Severity of functional impairment (such as joint mobility)

4. Stigma (how much is the patient disturbed?)

A standardised colour photograph of the scar lesion at each consultation provides a reference to evaluate effectiveness of treatment since changes occur slowly. The presence of a positive family history, previous abnormal scarring in the same or other anatomical sites, poor response to treatment or recurrence of scarring, specific anatomical locations (such as the sternum), large size, prolonged inflammation, and severe symptoms are associated with abnormal scarring.

Current methods of treating problematic Scars

A simple plan of treatment can be offered with three courses of action-non­invasive treatment, invasive treatment, and leave alone management. Non­invasive options include use of compression therapy (such as pressure garments with or without gel sheeting); static and dynamic splints; acrylic casts; masks and clips; application of a variety of oils, lotions, and creams; antihistamine drugs; hydrotherapy; and psychosocial counseling and advice.

We already reviewed silicon sheeting. Massage therapy is often advocated but lacks evidence of benefit. Further below we will analyze why a topical cream made with the ONLY natural substance that functions as a complete and balanced solution for the protection, repair, renewal and moisturizing of skin of a little creature that secretes it and bubbles it onto its skin may provide significant improvements to those suffering from scars and a welcome product for those willing to prevent scars before surgery or before and after scar revision procedures, as it signals the body that it is being taken care of and does not need to respond by inflammaging the area.  

Invasive treatments include surgical excision and resuture. Generally, revision should be considered only if the surgeon thinks that more favorable conditions for wound healing can be provided than on the first occasion (less inflammation, better technique). Intra lesional corticosteroid injection is widely used but is prone to complications (fat atrophy, dermal thinning, and pigment changes). Other treatments that have been advocated with variable outcomes include injections of fluorouracil, interferon gamma, and bleomycin, radiotherapy, laser therapy, and cryosurgery. 

Leave alone management - Most scars are best left undisturbed by invasive treatment for a year to mature before any judgment is made on their appearance. Monitoring (wait and watch) will allow ongoing assessment of appearance, symptoms, and psychological impact, and reassurance is important. Some scars are best left alone in the long term. Informed, shared decision making with patients may help reduce inappropriate demands for treatment.

When such management plans are applied to specific scar types, certain patterns emerge:

• Treatment of widespread scars is mostly by revision surgery to narrow the width of the scar. Revised scars in anatomical sites subject to excessive tissue mobility such as limbs can benefit from splinting.
• Atrophic scars have been improved with chemical peels, cutaneous laser resurfacing, dermabrasion, punch excisions, and the use of soft tissue biological and alloplastic biological fillers. Some of those can be performed by non-medical specialists, and we will review them further below.
• It is important to distinguish between hypertrophic and keloid scars as inappropriate management can lead to recurrence and larger scars. Simple surgical excision of keloid scars has a 50%­80% risk of recurrence. A combination of surgery with either intralesional corticosteroid injection or radiotherapy has been the mainstay of treatment.
• For scar contractures, surgical release with splinting, acrylic casting, and compression therapy may be required. Full thickness and split or partial thickness skin grafts and, perhaps more effectively, local and free flaps are used for reconstruction of difficult and extensive scars and contractures.

Next > Candidates for pharmaceutical scar prevention drugs for adult injuries at the stage of clinical trials, announced to be ready for marketing in 2009.

A natural skin care product for keloid & hypertrophic scarring