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There are various reasons people develop unsatisfactory scars. These could be secondary to injury or trauma or an operation. Sometimes they can develop for unknown reasons but usually this will be due to an injury which the patient is not aware such as picking at a pimple.
Scars can be raised (hypertrophic and keloidal), widened or stretched, depressed, atrophic, pigmented or depigmented.
Hypertrophic scars are more responsive to treatment than keloidal scars. It is important not to embark on any invasive treatment until after due consideration as most scars improve with time.
Massaging the scar with moisturising cream three to four times a day for a period of about three months can help. The scar is firmly kneaded with the tips of the finger, using the cream as a lubricant.
Pressure therapy – pressure garments can be applied. These are more effective with hypertrophic scars. With respect to the ears, custom made clip-on earrings which apply pressure can be made. These will need to be worn for at least six months.
Silicone – this is available in sheets or in a gel form. Prolonged use of this treatment is required. The use of the recently available gel form has increased usage of this method of treatment.
Steroids – these can be put directly onto the scar using adhesive tape or injected into the scar. This can be done in the out-patient clinic. Most children will require some form of quick general anaesthetic. These injections are normally administered usually every four to six weeks. Most patients require a few injections for a consistent effect.
Side-effects of the use of steroids include thinning of the skin (atrophy), loss of pigment (this can be quite troublesome in black skinned people) and development of thread veins (telangiectasia).
Radiotherapy – usually reserved for keloid scars that have not responded to any other form of treatment and usually combined with surgical excision. The risks of radiotherapy include skin changes and in the long term risks of malignancy including skin cancer.
Usually combined with the previously mentioned modes of therapy. The most common form of excision is an intralesional excision where the bulk of the scar is reduced, leaving only the rim. This is followed by intralesional injection of steroids at the operation and interval intralesional injection of the steroids (at six week intervals) to reduce the chances of recurrence.
This is usually under an hour.
Most can be done under local anaesthesia. The larger and more extensive scars will require general anaesthesia.
Most patients go home the same day.