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What is a scar?
Most of us have experienced having a few battle scars at some point in our lives. Scar tissues, which are the result of function of skin's repair system, are filled mainly with collagen. They don't follow all skin injuries but the ones seem to be more serious than a simple cut or scratch. This injury at epidermal level could be result of burn, acne , persistent inflammation and accidents. this excess collagen is also associated with hapharzard arrangement of collagen and elastin bundles which gives scarring an appearance different from that of surrounding skin.
Recovery in time
Time is a key element. Many of these marks fade away or very minimized in time. This in particular applies to facial scars and post inflammatory pigmentation.Therefore any consideration for an invasive procedure such as a laser treatment should be delayed for sometime, maybe two to three months. For those that stay longer, there are many available procedures and creams that can help minimize appearance of scar tissue. Although fresh lesions respond better to laser and some of them totally disappear, response of old scar tissue to treatments is not insufficient. We follow treatments later in this page. Let's see how prevention can aid decreasing the appearance and development of these disfiguring marks.
How to prevent a disfiguring scarring?
Many studies indicate that covering a wound can help flatten scar tissue, especially the types, which are more raised such as keloids. Most , not the ones resulted from adult acne, benefit from applying constant pressure on the wound with special bandages or silicone sheets.
External stitches that remain on the skin for long time can cause more skin irregularities. So it is adviseable to remove stitches after the first week.
Wounds should be covered. The more moisture reaches a surface of a wound, the more likely formation of new scar tissue. Applying an ointment of antibiotic under a bondage is a good way of preventing infection. Infection is the worst enemy for wound healing.
How about cleaning a wound? Major reason to delay healing of a wound is infection. So disinfecting a wound is the most crucial measure in its care. Use of hydrogen peroxide to disinefect a wound is quite common. However, some studies suggest that hydrogen peroxide may destroy the new skin cells that immediately begin to grow. To be on the same side use alcohol to clean the cut.
When it comes to vitamins which one really help? One study suggest that vitamin E has been shown to impair wound healing. Instead vitamin C helps with collagen synthesis and wound healing.
Always watch an allergic reaction, for example due to the bandage. This can be detected by noticing redness or itchiness over a lesion.
I
have this scarring, how can I treat it?
Mild to moderate forms
of a scar could be well treated with
topical scar creams or resurfacing scar serums
such as Hippocrates
Kit for acne, advisable for people who still have active breakouts,
or Hippocrates
scar serum, suggested for those
who stopped having breakouts for at least six months. These scar treatment modalities provide you with a moderate peeling that can be incorporated into
your skin care regimen at home. However, extreme care must be exercised
in use of these high-potency serums , because they are highly potent
with therapeutic effects, however, very safe with no side effects. Serums are also more advisable to patients
whose skin is still acne prone and are likely to develop blemishes
from time to time. This approach will efficiently help with
treatment without any side effects. In addition, you will be enjoying
a nourishing retexturizing scar creams, which not only root out
scarred skin but also revitalize and protect your skin against free
radicals and aging process. It is also to note that many available modalities in the present market are ineffective, an example is onion extract for treatment of skin scars.
Scar treatment solutions, a hype or reality, Can I really get rid of scarring?
The first thing one think
of when it comes to a hypertrophic or atrophic scar is that whether his/her skin tissue
can be returned to its original state. If you have gone through
our pages you might have realized that there are invasive and non-invasive
approaches to facial scars resurfacing. Among invasive scar treatment methods subcision and punch graft could be named.Surgical treatment of scarred skin
like laser resurfacing typically cost more than other methods such
as Hippocrates at-home regimen. Let's first take a look at the costs
and recovery time, which basically are two important factors when
considering any of these scar treatment solutions.
Laser
resurfacing cost varies between $2000 to $4000 depending
on the size of the treated area. Recovery time 4-6 weeks
Dermabrasion
facial procedures range from $1500 to $2000. Recovery time at least
2 weeks
Chemical peels
ranges from $200 to $1500. Time for recovery is at least 2 weeks
How
effective treatment methods are?
Now another factor comes
into play, that is efficacy of each approach. This is highly dependent
to scar type and depth. For instance, laser does not improve an ice-pick
scar (see image) to a great extent. In contrast, its effect on a hypertrophic
scar is significant. None of these methods can eliminate deep lesions
completely. However, all improve damaged skin's appearance and make
skin scar more superficial. There are some other considerations
when you are to decide which one works for you such as skin color
and type. However, you should first decide whether you want to go
for an invasive or non-invasive procedure. If your decision is an
invasive office procedure then a plastic surgeon can help you with
the rest of your question.
Non-invasive
scar treatment methods, Do they work?
Among this group of
treatments there are two main categories. Silicon sheets and
cell turnover accelerators. Silicon sheets are only indicated for
either a hypertrophic scar (see image) or the one remained as a result of surgery.
They may not have any effect on an atrophic scar (see image). Among cell turnover
accelerators or exfoliants alpha hydroxy acids or AHA's, beta hydroxy
acids or BHA's and retinoids can be named. AHA's is a compound found
naturally in many common fruits such as pineapple, berries, grape,
sugar cane. Among them glycolic
acid, found in sugar cane and sugar beets, have been used more
prominently in cosmetics. AHA main action is to accelerate shedding
of skin cells in the topmost layers of the skin by decreasing their
cohesiveness. Continued use of glycolic products may result in a
smoother epidermis and to some extent elimination of comedones (blackheads
and whiteheads). In doing so AHA generally can enhance the penetration
of other agents and nutrients such as Vitamin C, Zinc, amino acids,
essential fatty acids and ceramids. Simultaneously it helps to restore
the barrier function of the skin, thereby increasing tissue own
moisture content. There are evidences that suggest increase in collagen
production in dermis layer with use of AHA. Glycolic creams can
make the skin more sensitive to the effects of the sun’s UV rays;
therefore use of effective sunscreen is essential. Having said all
that can AHA alone be used for scar revision or does it have a significant
effect in reducing a scar. The answer is pH and concentration of
AHA determine success of glycolic products. However, glycolic acid
products in their highest concentration available and in lowest
pH tolerable by skin can not improve skin scar by themselves.
Beta
hydroxy acids are another modlaity among non-invasive scar treatment methods. BHA's, are another group of cell turnover accelerators which
are derivative of aspirin and naturally can be found in willow bark.
The most well-known BHA is salicylic acid. Some authors claim that
BHA's are stronger exfoliants than AHA's and interestingly more
gentle to the skin. A salicylic cream is also pore-clearing and
can help with blackheads and comedone clearance. Use
of BHA's alone is not very promising,
even though overall somewhat smoother skin is the net result of
using a salicylic preparatioins for at least three months.
Other treatment approaches.
Retinoids are derived from Vitamin
A. Retinoids could be found in alcohol form (retinol or acid
form of retinoic acid- Retin-A cream). Unlike their close structures,
retinol and retinoic acid seem to act very differently on epidermal
tissue. Retinol by helping to restore the barrier function of the
skin is very hydrating to the skin. On the contrary, retinoids
are very drying and irritating to the skin. Interestingly, keratolytic
effect of retinoic acid is different from that of retinol. Retinoic
acid causes desquamation of skin tissue, so
dead cells get separated more readily (smoother skin ). It also
appear to help collagen synthesis (firmer skin and fewer wrinkles),
as well as redistribution of melanin (skin pigment) by which even-tone
the skin. Effect of retinol treatment creams sounds very
limited.
Use of anti oxidants such as alpha
lipoic to treat a hypertrophic or atrophic scar is very questionable. It is very
skeptical to assume alpha lipoic creams or bioflavanoids, known
anti oxidants, can change the collagen rearrangement in dermal layer
of the skin. This more sounds like a cancer patient taking vitamin
pills to cure its cancer. Vitamins will help immune system but hey
will never be able to cure any form of cancer. Effect of lipoic acid on oxidative damage could be perceived as a protection against any new damage. However, skin damages already taken place in the epidermal and dermal layers could not be altered by oral or topical application of this substance. Lipoic acid
is a substance with strong anti oxidant activities, however, its
effect in improving scar tissue remains undetermined.
References:
1. D A McGrouther, MWG Ferguson, skin scars developement, BMJ. 2003 January 11
2. HAKVOORT T. E. (1) ; ALTUN V. (1) ; RAMRATTAN R. S. 1999, vol. 434, Epidermal participation in post-burn hypertrophic scar development 3. B R Klass, Postgraduate Medical Journal 2009, Transforming growth factor β1 signalling, wound healing and repair |