PROBLEM SCARS, KELOID AND HYPERTROPHIC SCARS

No-one wants a scar. If scarring has to happen, we want the scar to be as fine and as near to invisible as possible. Unfortunately, for some people scarring can be a real problem. Abnormal scarring can produce visible lumps, which may be obvious. It can also cause pain or itching. In my experience, itching is often the worst aspect of these scars.

Scar treatments: the problems

Over the years, there have been a number of different scar treatments developed but problematic scars are challenging to treat in a predictable way and no treatment has been shown to cure all problematic scars.

Scar treatments: possible solutions

As an evidence basis for treating hypertrophic and keloid scars, I use the ‘International Clinical Recommendations on Scar Management’, which was written by the International Advisory Panel on Scar Management in 2002. Of course, this means that their guidelines, although important, are now more than ten years out of date and a few advances have been made since then. I will discuss all the possibilities for treatment of scars, both non-surgical and surgical, with you in the clinic.

Cryotherapy – CryoSafe Freezing Treatment

This is a relatively new type of treatment for problematic scarring that involves freezing the scar tissue from the core to the outside. The results are very encouraging and I am now certified to deliver this treatment. It can be given in the treatment room of the clinic, with a local anaesthetic injection. The scar will need dressings for about four to six weeks.

Steroid Injection

This is a well-established technique for treating scars. It can be done in the clinic room and tends to work well in most hypertrophic scars and some keloid scars. Its benefits are that it is quick and tends to reduce both the thickness of the scar and the associated itch. Drawbacks are that the treatment is a bit painful and may leave a little chalky residual whiteness within the scar. If it occurs, this usually disappears after a few weeks. Most scars will require about six injection treatments, spaced about a month apart.

Laser Treatment

This was the main focus of my doctorate. Lasers can offer improvement for many types of scars but work best in scars that are red. They are tremendously effective in reducing itching in scars and may also reduce the scar’s thickness. The treatment will sting a little and will leave a bruise-like mark in the scar, which disappears over about two weeks.

Surgery

Surgery can be used to change the line of scars and to help reduce the size of some large scars. In some extensive scars, the whole scar may be removed and a special skin substitute may be applied to improve the contour and texture of the skin. You must remember though, that no surgery can make scars completely disappear. Anyone who tells you they can make scars disappear (without using make-up) is lying to you. Occasionally, in keloid scars which have not responded to other forms of treatment, surgery may be carried out, sometimes in combination with radiotherapy.

Radiotherapy

Low dose radiotherapy is sometimes used following removal of a scar that has not responded to other treatments. If I think you would benefit from this, I would arrange for you to be seen by the consultant radiation oncologist, who would give the radiotherapy. They would counsel you regarding the expected benefits and risks of this treatment. If you decide to have radiotherapy, we would co-ordinate your treatment so that you would have the scar excised on one day and then receive the radiotherapy the following day. Usually, only one or two radiotherapy treatments are required.

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