As injured skin may take up to 12 months to reach cosmetically acceptable healing, it is important to have scars assessed by a dermatologist who may recommend a "wait and see" approach, or decide if early intervention is indicated. Dr Bekhor has a special interest in scar management and has worked for many years to design treatment protocols. There are no miracles for permanently scarred and damaged skin, but there are some treatments, either laser or cosmetic intervention, which may soften the obvious changes such as persistent redness, brown pigmentary change or thickening of scar tissue.
Most scars will be red during the healing phase and in most cases this will fade spontaneously. Persistent redness in scars may respond to Candela V-beam™ laser treatment, the same laser used to remove blood vessel blemishes and birthmarks.
Some people have a tendency to develop brown pigmentation in areas of damaged skin. It is usually transient but if it persists beyond nine months, treatment with the Q-Switched YAG laser or the Q-switched Ruby laser may help fade the pigmentation. Treatment with a prescription "fading" cream such as Hydroquinone 4% may be helpful.
Raised (hypertrophic) scars and keloid scars
In extreme cases, scar tissue may "over grow" causing thickened, raised scarring. This condition is known as hypertrophic scarring. It will usually settle spontaneously over 12 months. This improvement can be accelerated with treatment. Unfortunately, in some individuals, these changes do not settle and treatment may be required.
In some people this scarring reaction is so severe that even a scratched mosquito bite results in a thick scar. People who are prone to this type of "over healing" are usually aware of the problem and this is one situation where early intervention is appropriate. After taking a history and inspecting other scars, a dermatologist is able to abort the over growth of scar tissue with regular micro-injections of cortisone solution. If the problem is not identified until after scar formation, the tissue may still respond to micro-injection treatment. Silicone sheeting designed to flatten scars may also have a role in the treatment of raised scars.
Keloid scars are a more severe problem and the tendency is often genetic. It is more common in darker skin types. The classic feature of keloid scarring is that it grows and invades beyond the site of the actual injury. It is also often exquisitely sensitive and prone to itching. Keloids scarring commonly occurs in acne scars on the chest and back.
Treatment for keloid scarring is similar to that outlined for hypertrophic scarring. It also has the tendency to recur over the years and require repeated courses of treatment. People prone to keloid scarring should consider preventative treatment as early as possible following injury and avoid unnecessary surgery.