Scars shape lives

Scarring – an under-managed problem:

• A scar is made of collagen fibres and is an essential part of the natural healing process following an injury to the thick layer of the skin (dermis).
• Scars look and feel different from normal skin because they have a different composition, structure and function.
• The appearance of scars is numerous: There are over 11 million keloids in developed countries [1], and the incidence of hypertrophic scars is possibly higher. [2]
• On average, plastic surgeons are seeing 40 000 patients a year with a linear hypertrophic or keloid scar. [3]

“Abnormal scars can cause unpleasant symptoms and can be aesthetically distressing, disfiguring and psychosocially and functionally disabling.” BMJ 2003 [1]

• Hypertrophic scars can be “especially severe in children”, causing “much functional, cosmetic and psychological morbidity.” [4]
• Existing scar remodelling and prevention procedures can be painful, invasive, hard to use or have limited efficacy. [5]

2002 International Clinical Recommendations on Scar Management – only silicone gel and intralesional steroids have sufficient clinical evidence to be endorsed by scar experts. [5]

The human impact of scars

Scarring can cause distress

A scar may appear redder and thicker at first, and then gradually fade – but not all scars fade away as quickly as we would like and some become abnormal.

Abnormal scars:

• Grow bigger
• Remain red/dark and raised without fading
• Cause discomfort, itching or pain
• Restrict the movement of a joint
• Cause distress because of appearance

Types of scars

Hypertrophic scars

Raised scars that remain within the boundaries of the initial lesion; often red, inflamed, itchy, painful

Keloid scars

Raised scars that spread beyond the edges of the initial wound into the surrounding normal skin; continue to grow over time and do not spontaneously improve

New scars

Scar prevention measures can be taken once the wound has closed and the skin is unbroken

Atrophic scars

Flat, depressed below the surrounding skin; generally small and often round or inverted; commonly arise after acne or chickenpox

What options are available? [1, 5]

Currently available therapy options for scar treatment/prevention include:

Non-Invasive

• Silicone gel sheeting, e.g. Dermatix
• Pressure/compression therapy
• Topical steroids
• Counselling
• Polyurethane patches
  
  

Invasive

• Surgery
• Injected steroids
• Radiotherapy
• Cryotherapy
• Laser therapy
  
  

Other treatments (no medical evidence)

• Topical vitamin E cream (and other moisturisers)
• Plant extract creams
• Massage therapy
• No treatment