Scars And Scar Treatment

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-11-27 18:19

Scars occur when a wound heals after a skin injury. Scarring is the final step in successful wound healing. Scars replace the injured or destroyed skin with the formation of less elastic replacement tissue. Scars change over time (scar maturation), with some scars disappearing completely and other scars remaining visible for a lifetime. Patients can also make a contribution themselves to ensure that a scar heals as well as possible, for example by caring for the scar or sun protection. In rare cases, scars proliferate. Atrophic scars, hypertrophic scars or keloids form. These scars can cause painful discomfort and become a psychological burden for those affected. There are different therapies for conspicuous or abnormal scars…

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How do scars arise?
What types of scars are there?
Which complaints can arise?
How is the diagnosis made?
How are scars treated?
">How is diseased scars treated?

What can the patient contribute to the healing process?
Whom can I ask?
How are the costs going to be covered?

How do scars arise?

A fresh wound first closes with temporary, less stable granulation tissue. After that, fibers of collagen grow into the granulation tissue. The blood supply is increased. The fresh scar is initially red and raised. After a while (months to years) the blood flow decreases and the collagen contracts. The scar sinks in, becomes softer and paler. After about two years, the scar is complete. But even after that, a scar can change its appearance.

Various factors influence its size, shape, appearance, etc. when a scar develops:

Size and type of wound,
Location of the wound (more scars are formed in areas with increased skin tension),
Wound hygiene and wound healing (infections and impaired wound healing lead to increased formation of scars),
Age (scarring is more severe at a younger age than at an older age),
Medication intake and comorbidities,
Nutritional status and immune status,
hereditary factors and
Scar care.

What types of scars are there?

At the end of the healing of a wound without disturbances and complications, usually flat, pale and soft scars are formed. Usually these do not cause any symptoms such as redness, adhesions and itching. Other injuries, especially deep and large wounds, heal with large, sometimes noticeable scars.

Disorders in wound healing can also lead to pathological scar formation. These include:

Atrophic scars (scar depressions): After the wound has healed, too little tissue has formed to completely fill the wound. Sunken scars are often a result of acne.
Scar contractures: The scar tissue contracts and hardens. Scar contractures often occur with extensive injuries, sores, or burns. Tensile forces act in different directions on the scar. They are not cosmetically attractive and can restrict mobility, especially in the joints.
Hypertrophic scars: Scars grow and proliferate excessively. However, the scarring remains limited to the wound area. Hypertrophic scars usually develop on the flexor side of joints and after burns. They can also regress spontaneously or through therapy.
Keloids (Narbenwülste, keloids): The scar tissue grows into and in the adjacent areas of the skin. Keloids initially form as a rubbery red growth of connective tissue. It later becomes dark red, firm and often itchy. Keloids often form in people with dark skin and usually on the shoulder and chest or ear. The top layer of skin on keloids is thin and vulnerable. Wound infections increase the risk of keloids. The excessive scarring begins about three to four weeks after the injury. The growth can continue to grow for years. Keloids don't regress on their own.

Which complaints can arise?

Large or abnormal scars, such as hypertrophic scars or keloids, can cause discomfort, e.g.

Burning, itching, pain,
Feelings of tension in the skin and underlying tissue,
limited mobility,
low resilience of the skin,
Accumulation of fluid (edema) in the area of the scars,
impaired sensation, e.g. temperature, pain, sense of touch as well
aesthetic or cosmetic impairments and psychological stress.

These symptoms may require scar treatment. Contact your doctor for advice.

How is the diagnosis made?

First the doctor will take the anamnesis and ask various questions:

How long does the scar last?
Does the scar cause discomfort?
Is the patient restricted by the scar?

The doctor then inspects the scar and assesses the healing of the wound, the nature of the scar, the shape of the scar, the formation of edema and blood circulation. Then she / he carries out a palpation examination in order to get additional information about the scar, e.g. about the tone of the tissue, adhesions, pain etc. After the diagnosis, the doctor suggests a therapy plan and clarifies the patient important points of therapy on, e.g.

What is the goal of therapy? (For example, the scar is reduced by around 50 percent after around six months.)
How good are the chances of success?
How likely are new scars?
What are the advantages and disadvantages of the treatment?
What side effects can occur and how likely are they?
How often is therapy prescribed and how long does the entire treatment last?
What can the patient contribute?

How are scars treated?

Various therapies and care measures are available for the treatment of scars. Depending on the treatment, they are carried out by, for example, a doctor or, if prescribed by a doctor, by a physiotherapist or an occupational therapist.

For optimal treatment success, the patient is instructed to carry out certain massages and care measures such as spreading out, applying lotion, etc.

The treatments pursue various goals: improve blood circulation, reduce edema, relieve redness, itching and pain, improve the elasticity of the tissue, reduce adhesions (contractures, adhesions) and relieve pain.

Measures to treat scars include:

Light massages of the tissue next to the scar and on the scar itself (pull massage) to improve the elasticity of the scar. Ev. scar ointments or gels with special active ingredients, e.g. allantoin or dexpanthenol, are carefully massaged into the scar tissue.
Smear the scar and the area around the scar with the hand or a soft cloth in the direction of the heart or the core of the body to activate the lymph and reduce edema.
Warm baths and care of the scar with a care product, olive oil or marigold ointment.
Ev. Targeted therapies to prevent pain, adhesions and pathological scars, e.g. manual therapies, stretching, mobilization, etc.
Compression with tapes, envelopes, etc.
The negative pressure vacuum massage (cupping) is mainly used for small local scars, e.g. on the ear, neck or face. The scar is gently massaged and stretched with special suction attachments.
Care of the scar with silicone to keep the scar moist and supple. This is to prevent the development of hypertrophic scars or keloids. Silicones are available as gels, creams, pillows, pads and foils. Special ointments or onion extract can also be used for care.
Ev. Addition of selected vitamins and minerals.

How is diseased scars treated?

The following special measures can be used for conspicuous or pathological scars (atrophic or hypertrophic scars, keloids):

Treatment of atrophic scars

Injection (injection) of filling substances, eg collagen: The aim of the therapy is to fill in the missing tissue. However, the effect is limited in time and there is a risk of inflammatory reactions.

Grinding (dermabrasion): Sunken scars can also be treated by grinding the top layer of skin or the edges of the scar.

Treatment of hypertrophic scars and keloids

Injection of glucocorticosteroid (cortisone): Injection of glucocorticosteroid (active ingredient triamcinolone) into the scar can inhibit the excessive formation of connective tissue in hypertrophic scars and keloids. This is to reduce the strong scar growth. The injections can be painful. The undesirable effects of injecting too deeply include tissue shrinkage (atrophy) and pigmentation disorders. The success rate (response rate) with keloids is high (between 50 and 100 percent) according to the guidelines of the German Dermatological Society. The probability of a new formation (relapse) is up to 50 percent. Before doing this, the doctor can apply freezing (cryotherapy) to the scar to make the injection easier. In children, glucocorticosteroids are contraindicated due to possible side effects.

Cryotherapy (icing): Cryotherapy is mainly used for keloids and small hypertrophic scars. The scars are frozen with liquid nitrogen and then removed. The treatment can either be carried out with short freezing (in front of a glucocorticosteroid injection) or with intensive freezing. After freezing, a blister with an oozing wound forms. For a sufficient effect, the treatment must be repeated more often. However, this is only possible after the blister has healed after about four to six weeks.

Pressure treatment: By applying pressure to a scar, the maturation of the collagen should be accelerated. The pressure flattens the scar, supports the conversion of the replacement tissue into functional tissue and increases the elasticity of the scar. The pressure should be maintained throughout the day if possible. Depending on the scar, the treatment lasts six months to two years. The success of the treatment is documented during the regular medical checks. Pressure treatment is possible with:

Elastic textile fabric, e.g. compression suit, stockings, gloves, bandages for large scars, especially after burns or
Plastic masks.

Needling (microneedling, collagen induction therapy): The scar tissue is treated with a special roller with many small, thin needles. This results in tiny injuries. This supports wound healing and, among other things, stimulates the formation of collagen. The simple, safe and effective therapy method is used, for example, for acne scars, burn scars or stretch marks and can possibly be combined with other therapies.

Surgery: Surgical treatment of scars is usually considered after a year at the earliest, as scars can recede by themselves beforehand. During the treatment, all or part of the scar tissue is removed. The wound is then sutured or replaced with transplanted tissue. Accompanying therapies, such as radiation therapy for keloids, are often added. Treatment may be indicated for various reasons when:

Scars restrict mobility, e.g. scars on joints,
the scar creates tension that leads to growths,
there is a cosmetic disfigurement or
a new wound healing process without pathological scarring with appropriate accompanying treatments should be initiated.

Laser therapy: Using special laser techniques, hypertrophic scars can be removed and the tissue smoothed. Several sessions are often necessary. Unwanted side effects can include scabs, erythema or infections. For certain keloids, the doctor can suggest laser treatment in combination with other therapies, e.g. glucocorticosteroid injections, cryotherapy, pressure treatment, etc.

Radiation: Radiation is intended to limit excessive cell growth and support normal scarring. The irradiation is carried out shortly after the surgical removal of a diseased scar. Unwanted side effects are, for example, temporary redness or flaking as well as chronic hyperpigmentation and depigmentation. The dosage is chosen to keep the risk of adverse effects as low as possible.

Silicone cream: Silicone is used as an additional therapy for hypertrophic scars or to prevent hypertrophic scars and keloids after an operation.

What can the patient contribute to the healing process?

Patients can make a contribution themselves to ensure that a scar heals as well as possible.

Scar care

Following the instructions of the doctor or therapist, you can carry out various care measures yourself. These include:

Avoid tension and tension on the wound,
daily bath of the scar with curd soap,
lightly massaging the scar with circular movements towards the scar, approx. five minutes, several times a day,
Smoothing out swellings and edema,
Creaming the scar, e.g. with olive oil, Vaseline, silicone-containing cream or marigold ointment,
Envelopes and compresses with chamomile, lavender oil or onion extract.

Scars and sun protection

Scars are pale in color because they do not contain melanocytes for color formation (pigmentation). However, over time, melanocytes can migrate into the scar. Because of the lack of or hardly any pigmentation in the scar, the skin at this point has little protection from UV radiation. Therefore, sun protection with suitable sunscreens is particularly important so that there is no noticeable scar with skin damage. Direct sunlight and solariums should also be avoided for about six to twelve months after the wound has healed.

Life with scars

A balanced, vitamin-rich diet with fresh fruit and vegetables supports the healing of a scar. Smoking worsens blood circulation and also has a negative effect on the healing of the scars.
High or low temperatures can irritate fresh scar tissue and disrupt the remodeling processes of the scar.
Tight clothing, injuries or stress (strong pull or pressure) can irritate fresh scars.
Scars can be made less visible with a cosmetic cover (camouflage). This special make-up is available for different skin types, for example in pharmacies.
Scars can represent an aesthetic impairment and be psychologically stressful for those affected. Psychologists or psychotherapists offer support with these problems.

Whom can I ask?

For the treatment of scars, you can turn to:

treating doctors in the hospital, e.g. after an operation or a serious injury or burn,
General practitioner (general practitioner),
Specialist in skin and venereal diseases (dermatology),
Skin clinic,
An operation can, for example, be carried out by a specialist in surgery or in plastic, reconstructive and aesthetic surgery.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (treatment contribution) (BVAEB, SVS, SVS, BVAEB). However, you can also use a doctor of your choice (ie doctor without a health insurance contract). For more information, see Costs and Deductibles.

For certain examinations (e.g. MRT), approval from the health insurance provider responsible (medical service - "chief physician") may be required, as well as for certain drug or non-drug treatments (e.g. physical therapy), in some cases only when a certain level is reached. For certain services (e.g. inpatient stays, aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. Most health insurance providers provide for a permit, sometimes depending on the type of medical aid. The prescription fee has to be paid for medication on a “cash prescription”. For more information about the respective provisions, please contact your health insurance provider,which you can find on the Social Security website.