How does scarring occur

Only a few studies have tested the effect of injectable bleomycin on improving the appearance of hypertrophic scars and keloids. Some researchers have found that bleomycin may also reduce redness, itchiness, and pain associated with these scars.

Bleomycin is a treatment that doctors use in cancer treatments. It is a toxic substance, but doctors rarely report toxic side effects from injecting it into a scar. Interferon also affects the production of collagen, and doctors can inject it into injured tissue. This produces a more significant effect than injecting a corticosteroid. Another study showed that after injecting interferon into a hypertrophic scar, the quality and volume of the scar improved.

Doctors do not typically use interferon because it is expensive, and current evidence is not strong enough to support its use. It also requires three injections per week, which may be inconvenient for some people. Doctors prefer corticosteroid injections as the first choice for treating keloids and second choice of treatment for hypertrophic scars. Doctors use triamcinolone acetonide, which is an injectable corticosteroid. The recommended dosing schedule may vary, but a typical injection schedule involves three to four injections every 3 to 4 weeks.

Some people may require more than four injections. Some doctors have been injecting botulinum toxin A to prevent and treat scars for several years, but researchers have found inconsistent evidence for its effectiveness in scar management. Cryotherapy involves using liquid nitrogen to cool body tissue to below zero temperatures. This seems to have an effect on scar management. This treatment may have a benefit in improving the appearance of scars by affecting the underlying scar tissue.

Doctors may use radiotherapy along with other scar treatments. Typically, people will receive radiotherapy after having a keloid removed to reduce the formation of another keloid. Radiation can help to reduce cell growth and prevent collagen from depositing in the injured tissue. Doctors caution the use of radiotherapy on scars located on the neck or chest because there is an increased risk that a person may develop thyroid or breast cancer as a result of the radiation. There are two types of laser therapies for treating scar tissue: ablative and nonablative.

A doctor will use ablative laser therapy to flatten scar tissue. Nonablative laser therapy can disrupt the blood supply in the scar tissue, which will eventually kill off the abnormal tissue.

Overall, researchers have shown that laser therapy demonstrates good results for surgical scars, hypertrophic scars, and keloids. Applied in the form of a gel or pad, this can help soften and decrease the redness of keloids. If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound.

Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body called the donor site and attaching it to the needed area.

Surgery is not performed often on hypertrophic scars and keloids due to the high rate of recurrence or creation of even larger keloids. Laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar.

Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.

Pulse dye laser is a good choice to use for keloids. Hypertrophic scars are similar to keloid scars. But their growth is confined within the boundaries of the original skin defect and may be more responsive to treatment. These scars may also look red, and are usually thick and raised. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally.

But this process may take up to a year or more. In treating hypertrophic scars, steroids may be the first line of therapy. But there is not 1 simple cure.

Steroids may be given as an injection. Or they may be directly applied to the scar, although topical application may not be useful. These scars may also be removed surgically. Often, steroid injections are used along with the surgery. The injections may continue up to 2 years after the surgery to help maximize healing and decrease the chance of the scar returning.

Like keloids, hypertrophic scars may respond to topical silicone dioxide application. Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement. There are many different surgical treatment options for contractures, including the following:.

Skin graft or skin flap. Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Types of scars A scar can be a fine line or a pitted hole on the skin, or an abnormal overgrowth of tissue. Normal fine-line scars A minor wound like a cut will usually heal to leave a raised line, which will gradually fade and flatten over time.

Keloid scars A keloid scar is an overgrowth of tissue that happens when too much collagen is produced at the site of a wound. The scar keeps growing, even after the wound has healed. Hypertrophic scars Like keloid scars, hypertrophic scars are the result of excess collagen being produced at the site of a wound.

Pitted or sunken scars Some scars caused by skin conditions, such as acne and chickenpox , can have a sunken or pitted appearance. Scar contractures Scar contractures are often caused by burns. Treating scars Complete scar removal is not possible, but most scars will gradually fade over time.

If scarring is unsightly, uncomfortable or restrictive, treatment options may include: topical silicone gel or silicone gel sheets pressure dressings steroids skin camouflage make-up surgery A combination of treatments can often be used.

Read more about treating scars Emotional effects of scarring Scarring can affect you both physically and psychologically. Help and support A number of support groups and organisations provide help and advice for people living with scarring.

Stretch marks Stretch marks are narrow streaks or lines that appear on the skin's surface when the deeper layer of skin dermis tears. Other forms of treatment, like chemical peels or dermabrasion work by removing the outermost layers of skin. The skin then heals from this kind of controlled assault, and as a result the newer, younger skin could appear more uniform. But while each of these methods may result in an improved appearance for some folks under some conditions, none of them actually remove scars entirely.

They only alter them, adjust them, relocate them, or otherwise increase their acceptability. Only a skin graft can completely remove a scar, and even then a new scar will appear along the edges of the graft.

So until medical science comes up with something better, the majority of us will simply have to remain content with trading scar stories. If you liked this story, sign up for the weekly bbc.

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