Scars may result from injury to the skin either through skin conditions such as acne or from trauma which may be accidental or scarring following surgery. The type of scar can be further classified as raised (hypertrophic or keloid), depressed or atrophic. They may also have a different colour to adjacent skin being red or darker due to post-inflammatory hyperpigmentation which is more common in people with darker skin types.
Scars are due to injury to the deeper layers of the skin and how that skin repairs itself. If there is too much collagen in the scar tissue they may be raised to form hypertrophic or keloid scars, or conversely if there is too little collagen they may be indented or atrophic. They may also be associated with lines, lumps and redness, particularly post-surgical scars.
Some people are more at risk of forming scars including:
- a history of keloid scars
- a family history of scars
- a history of moderate to severe acne
- darker skin types
- procedures in areas with high tension across the skin such as the chest and shoulders
Treatment options for scarring:
- Surgical: surgical procedures such as scar debulking, z-plasty, subscision, and excision
- Intralesional Steroid Injections: to flatten raised scars
- Dermal Fillers: To decrease the depth and improve the skin of depressed or atrophic scars
- Ablative Laser: These lasers include erbium lasers and maybe either fractionated or full field. They work best on acne scars, raised scars, traumatic and surgical scars. They work by taking off the top layer of the scar and stimulating re-modelling of the collagen within the scar.
- Vascular Laser: This can be used for removing the redness from early surgical scars and red scars
- Pigment Laser: Q-switch lasers can be used to treat post-inflammatory hyperpigmentation or dark skin scars
- Topical Measures: The use of tape, pressure dressings, silicone gels and sheets can help treat and prevent scars from forming.
Depending on the type of scar different treatment options may be used in combination and may require several treatments for improvement.
Recent work suggests that early treatment with laser can improve results as well as pre-treating skin prior to a surgical wound. At Clinic 54 we offer both pre-treatment with laser prior to surgical excision of a skin lesion as well as early post-excision laser treatment to improve skin healing and minimise the appearance of the scar.