Scar treatment

Scar formation and scar treatment

Scars are formed as part of the healing process after your skin is damaged. The skin repairs itself by growing new tissue to contract the wound and fill any defects caused by the injury. Scar tissue consists mainly of a protein called collagen.

Scars come in all shapes and sizes. Some scars are large and painful, while others are barely visible. People with toned skin, as well as redheads, are more likely to develop keloid scars. Keloids are raised scars that grow and extend beyond the scar area. Depending on their size, type and location, your scars can look unsightly and even cause problems with movement.

Not all scars need treatment and many fade over time. If scarring is bothering you or causing pain, treatments can help.

The various types of scars

Scars can occur anywhere on the skin. There are different types of scars, including:

• Contracture: A contracture scar causes the skin to tighten. This often occurs after a burn. These scars can make it difficult to move, especially when the scars enter muscles and nerves or form over a joint.
• Atrophic scar: These sunken scars are often the result of chicken pox or acne. They look like rounded pits or small indentations in the skin. They usually develop on the face, and can become more noticeable as you age because the skin loses collagen and elasticity over time.
• Keloids: These scars rise above the surface of the skin and spread beyond the scar area. The overgrown scar tissue can grow large and affect movement.
• Hypertrophic scar: You may feel a hypertrophic scar if you run your finger over it. These thickened scars may shrink over time, but they never become completely flat. Unlike keloids, they do not grow or spread outside the scar area.
• Striae: When the skin expands or contracts rapidly, the connective tissue under the skin can become damaged. Striae often appear during pregnancy, puberty or after gaining or losing a lot of weight. They usually appear on the breasts, abdomen, thighs and upper arms.

Scar treatment

Treatments can improve the size or appearance of a scar, but the scar will never disappear completely. If the scarring is not good, scar treatment will be arranged in consultation with your plastic surgeon. There are several options for treating excessive scarring:

• Microneedling: In this technique, a small needle is used to work on the scar to stimulate collagen production. It can help smooth, firm and tighten the skin and improve the appearance of scars, acne and wrinkles.
• Silicones: Silicone is applied as a bandage (silicone plaster) or as a cream/gel. Hypertrophic and keloid scars can be treated with silicones. Silicone makes scar tissue softer and smoother. Additional symptoms such as itching, pain or redness are also reduced.
• Pressure therapy: An elastic bandage, compress or stocking exerts pressure on a wound during the healing process. The pressure prevents the formation of a scar or reduces its size. Massage therapy can also help break down scar tissue and allow it to remodel.
• Injections: Injections of corticosteroids can have a beneficial effect on the elevation, hardness, itching and soreness of the scar. The injections can be painful. To reduce the pain, the fluid is often diluted with an anaesthetic. The fluid is injected into the scar by the doctor at an interval of one to four weeks (the fluid works longer).
• Cryotherapy. This technique uses liquid nitrogen to cool a scar and adjacent tissues to temperatures below freezing. It is particularly suitable for the treatment of keloid scars, aiming to flatten the scar and inhibit its development.
• Scar correction: This is performed by the doctor. During surgery, the scar is removed and the skin edges are re-stitched. Sometimes the location of the scar is adjusted so that it “falls” better into a natural skin line. This may make it less visible or less under tension.
• Radiotherapy: In consultation with the doctor, it may be decided to affect the scar by radiotherapy.
• Camouflage: You may be referred to the skin therapist for advice on camouflage therapy. The skin therapist provides information on which agents can be used and also specialises in the treatment of fluid reduction through, for example, massage of the scar.

Reimbursement: scar treatment falls under insured care after referral by your GP.

What can you do yourself to prevent a scar?

• After surgery or during wound healing, it is unfortunately not always possible to prevent a scar. In the initial phase, it is better not to use creams. Let the scar settle down first. If the scar is dry or scaly, you can keep it supple with a moisturiser after one to two weeks. You may already be using a moisturiser that you like on your skin. You should not start using special scar cream until there are no more open spots in the skin!
• Clean the wound. Unless otherwise directed by your healthcare provider, you can gently wash the wound area with soap and water 48 hours after surgery. Remove any dirt or dried blood and apply a dressing over the wound to keep germs out. Be sure to change the dressing often while the wound is healing.
• Stop smoking! Smoking leads to poorer wound healing and greatly increases the risk of wound infections!
• Take care. Scars on the back and limbs are especially susceptible to too much tension. Strength sports and gymnastics can damage scarred skin.
• Protect it from the sun. Cover the scar or use sunscreen to protect it. Sun exposure can darken a scar. Repeated exposure increases the risk of developing skin cancer. Protect the scar with a sunscreen, at least SPF 30. Some scars, especially on the sternum, shoulder, shin, jawline and earlobe, heal more slowly. They also tend to form less nicely. Get advice on scar treatment options.