After any trauma, a memorial sign in the form of a scar remains on a person’s skin, which means “scar” in German. Sometimes these marks do not cause problems, as they are either not visible or almost indistinguishable from neighboring skin areas. But there are situations when the scars are too noticeable, convex, dark, sometimes with a very corrugated surface. These are hypertrophic and keloid scars. Of course, they are a significant cosmetic defect, especially if they are located on the face, neck, chest. It is not so easy to get rid of them, because this type of scars has a special fiber structure, which is difficult to correct.
Types of Scars
In some people, wounds heal quickly and almost painlessly. For others, this process lasts for weeks, and when, finally, the wounds heal, ugly rough marks remain in their place. Different “behavior” of tissues depends on many factors, for example, infection of wounds, their location (moving area or not), the size and depth of damage, the individual ability of the body to regenerate, the type of skin, and so on. The combination of all these reasons leads to the fact that in some cases the scars appear to be sunken (they are called atrophic), and in others they are at the same level as the skin integument (normotrophic).
The most problematic, from the standpoint of cosmetology, are hypertrophic scars. They appear when fibroblasts are too activated in the healing tissues of the wound and begin enhanced collagen synthesis. In this case, the collagenase enzyme, which destroys excess collagen, is produced in insufficient quantities. As a result of the new tissue, too much is formed. There is nowhere to surplus, and they bulge over the healed site of damage. The height of such scars can reach 10 mm. Their color is mostly darker than the skin in neighboring areas, and the surface often has a rough relief.
Keloids
These formations are very similar in appearance to hypertrophic scars, but have a number of unpleasant differences. The main thing is that keloid scars, appearing at the site of injury, grow on intact skin areas. The trigger for them can be a large cut or burn, or a minor injection, even an insect bite, which many do not pay attention to. A keloid scar begins to grow one month or more after wound healing. Growth can last up to two years, after which the stabilization stage begins. During histological studies in keloids, too active giant fibroblasts are found that continuously produce collagen. And if hypertrophic scars, although ugly, but painless, keloid can cause itching, pain, and increased skin sensitivity. Distinguish false keloids that appear at the site of injury, and true, which occur where the skin is not externally damaged.
Treatment of keloid and hypertrophic scars
To date, the following methods of correction of rough scars are used:
- compression;
- silicone preparations (plates, gel);
- laser therapy;
- surgical intervention;
- radiation therapy;
- cold treatment;
- drug therapy;
- corticosteroids.
Any of them has its advantages and disadvantages. Which method to apply, in each case, the doctor must decide. It is necessary to remove hypertrophic, and even more keloid scars, which are often diagnosed as dermatofibroma and even infiltrating cancer, in specialized clinics.
Surgical intervention
Hypertrophic and keloid scars are rarely removed surgically, because after such a correction there are almost always relapses. For example, if we talk about keloids, the return of the defect occurs in 80-90% of all registered cases and is manifested in the formation of scar tissue even larger than before removal. In the case of hypertrophic scars, the percentage of complications is slightly lower. Surgical correction is best tolerated by narrow scars with clear edges. During the operation, the surgeon excises them, compares the edges of the incision, makes an internal suture, which is hardly noticeable. This operation is performed under local anesthesia. Hospitalization is not required.
If extensive scars, for example, burn ones, are removed by surgical intervention, they make patchwork of the skin (transplant).
Compression
Hypertrophic scars in this way practically do not correct, but in the case of keloid it gives satisfactory results. The essence of the method is to apply a tight bandage to the scar site, which the patient wears without removing, from 3 months to a year. Sometimes a bandage may be applied every 12 hours. Due to pressure on the vessels of the scar, its nutrition is stopped. At the same time, the edges of the scar tissue are compressed, which prevents its further growth.
Radiation therapy
This method is considered the most effective and is used worldwide. The removal of hypertrophic scars, keloids and other formations on the skin is carried out by the so-called Bucca rays (X-ray radiation using ultra-precise beta applicators). As a result, fibroblasts are destroyed or stop their growth, collagen synthesis stops. Rays of different intensity can be used.
In any case, 90% of them are absorbed by the upper layers of the skin, and only 10% get into the dermis. Often this method is used in conjunction with surgical scar removal. Relapses after such therapy are registered in 50% of cases. In view of the features of exposure to x-ray radiation, the method is not used to remove scars in the head, neck, chest. Contraindications:
- oncology;
- diabetes;
- heart and vascular diseases;
- exacerbations of various diseases.
Cryotherapy
This is one of the safest and most effective methods. Keloids without relapse with the help of a cold completely disappear in 51% of cases. And in 76% of cases, hypertrophic scars are removed . The treatment should be comprehensive (cryotherapy and other methods - the use of ointments, silicone), then it makes sense to hope for the almost complete (90%) disappearance of scars, without complications and relapses. The essence of the method is to expose the scar to liquid nitrogen (temperature around -196 ° C). It is applied with a swab or a special applicator. As a result, ice crystals form in the cells, the cytoplasm and organelles die. So fibroblasts are destroyed, collagen synthesis stops. Exposure to nitrogen lasts a maximum of 30 seconds, but more often it takes 5 seconds. To completely remove the scar, several procedures are sufficient. The disadvantages of the method:
- soreness of the procedure;
- the possibility of a blister at the site of the scar;
- hyperpigmentation after the procedure.
Silicone treatment
Now pharmaceutical companies have developed gels containing silicone and special silicone plates. The principle of action of the drugs is approximately the same - they serve to maximize hydration and softening of the body of scars, blocking the access of oxygen to its fibers and reduce collagen synthesis.
This method removes atrophic and hypertrophic scars. It is not suitable for the treatment of keloids. Plates are available in various shapes and sizes. On the one hand, they have a sticky coating that provides the most tight bonding to the scar. Their structure is such that they pass air to the skin, while being waterproof. The advantages of the method are ease of use, relatively low price, painlessness and the absence of complications, allergies, side effects. Disadvantages: duration of the procedure (several months) and low effect.
Corticosteroids
Many people ask how to remove a hypertrophic scar quickly and with a noticeable effect. Injections of prolonged (with a long period of action) corticosteroids fulfill these wishes of patients, and good results are also achieved in the treatment of keloids. To date, Kenalog and Diprosan corticosteroids are used. Their mechanism of action is approximately the same and consists in reducing the number of leukocytes and cytokines, suppressing growth factor and proliferation necrosis, inhibiting the functioning of fibroblasts, relieving allergic reactions, and reducing collagen levels. The procedure is carried out 1 time in 10-14 days. Side effects:
- hypopigmentation;
- penetration of the capillary network on the skin;
- the appearance of steroid acne ;
- thinning of the skin;
- general negative effect on the body.
To reduce side effects, corticosteroids are injected together with lidocaine (1: 5), saline, pentoxifylline. An excellent result is given by this procedure together with cryotherapy.
Laser therapy
Grinding a hypertrophic scar or keloid with a laser gives the maximum effect. The essence of the procedure is to carefully and very accurately remove the upper layer of skin and scar tissue. As a result, the skin is renewed, new elastin and collagen are formed in the treated area, the bulge of the scar is reduced, it is practically compared with the integument surrounding it. After applying this method, hypertrophic scars completely disappear in 80-95%, and keloid scars in 60-70% of cases. Complications after the procedure:
- swelling
- hyperemia;
- increased sensitivity of the skin to the sun;
- erythema;
- hyperpigmentation (goes without treatment);
- acne;
- the formation of cysts.
Laser exposure is ambiguous (deeper) and non-cumulative (more gentle). In the second case, complications are usually less, but the duration of treatment is longer.
Drug therapy
There is an external treatment and through the introduction of drugs into the body of the scar. For injections, drugs based on hyaluronidase (an enzyme due to which hypertrophic scars become less swollen, soft, their relief is flattened) are used. These include Lidaza, Alidaza, Longidaza, Vilidaza and others. Injections should be done every day or every 2 days for 1-2 weeks. The disadvantages of the method:
- enzyme instability;
- adverse reactions;
- allergenicity.
For external treatment, ointments, creams, sprays are used. In pharmacies, there is a wide selection of drugs that remove scars. The most popular are Contractubex, Dermatics, Kelo-Cat, Kelobibraza. The advantages of the method are its ease, the ability to be treated at home, the absence of side effects. The disadvantages are in low efficiency.
Against keloid scars, ointments and injections do not help much, and the treatment is only complex.
How to avoid the appearance of rough scars
If the wound is too large, then the scar, one way or another, will remain. But in some cases, you can try to minimize its appearance. So, a hypertrophic scar after mole removal is almost never formed if the procedure is performed by cryotherapy, electrocoagulation, using a laser. If they eat a mole surgically, the scar always remains. And when you remove it yourself, at home, the inflammatory process can begin, which will further exacerbate the situation.
With any injury to the skin, so that the wound heals better and faster, you must follow some rules:
- do not allow dirt to get on injured areas of the skin;
- avoid rubbing and touching the wound surface (e.g. clothing);
- in no case to peel off the resulting crusts;
- cover the wound from direct sunlight;
- use special creams that help fast healing and reduce the risk of scars (one of the best among these drugs is "Contractubex").