The scar you received when you fell off your bike at age 12 or from a recent car accident may be a constant and painful reminder of the event. While you may not feel any physical pain from these wounds, scars can make you feel self-conscious or embarrassed, particularly if they are located on exposed skin.
Dermatologists now have many treatment options that can significantly reduce the appearance of scars or make them disappear all together.
Speaking at the American Academy of Dermatology’s (Academy) Derm Update 2004, dermatologist Tina S. Alster, M.D., clinical professor of dermatology, Georgetown University, Washington, D.C., discussed innovative treatments that dermatologists are using to remove or revise scars on all parts of the body.
Scars are an abnormal healing response of the skin to injury, resulting in atrophic scars, which are skin depressions, or hypertrophic scars and keloids, which are elevated. The larger the surface area of skin affected, the greater the chance of a noticeable scar. Scars occur with equal frequency in men and women, although they most often develop between the ages of 10 and 30. While scars can be disfiguring physically, psychologically, or both, hypertrophic scars and keloids also can be accompanied by significant itching and burning.
“The way a scar forms is affected by an individual's age and its location on the body or face,” said Dr. Alster. “Younger skin makes strong repairs and tends to overheal, resulting in larger, thicker scars than does older skin. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. Today, dermatologists are using the latest therapies, including lasers, to fade or remove all types of scars.”
Traumatic skin injuries, particularly those from an abrasion or imbedded foreign materials which leave a depression, can benefit from a variety of laser treatments. Even infants and children can be treated with the new generation of lasers that cause only minimal discomfort and require little or no downtime.
Scars with uneven surfaces, such as bumps or ridges, can be smoothed using a CO2 or erbium:YAG laser. This lasers vaporize the elevations of the scar and flattens them to produce a smoother surface. Younger individuals may require treatment only on the scar itself, while patients with mature or aging skin may require treatment over the scar and the surrounding skin to blend the scar more evenly with natural pigmentation, wrinkles or broken blood vessels.
The pulsed dye laser has been demonstrated to minimize the red color and thickness of some scars, while various Q-switched lasers also can lighten the dark color of scars. Some scars require treatment by a combination of lasers.
Other treatments may combine laser surgery with medical treatments, such as dermabrasion, to achieve the best overall results. Dermabrasion removes the top layers of skin to give a more even contour to the surface of the skin. While it can offer improvement for certain scars, the scar will not completely disappear. If a scar is minor, only one dermabrasion will be needed, but several treatments may be required if a scar is deep and extensive.
Injectable collagen, a natural animal protein, or hyaluronic acid also can be used to elevate indented, soft scars and while improvement is immediate, it is not permanent. Injections typically need to be repeated every three to six months.
Dermatologists also use several different treatments to improve raised scars. Lasers are particularly effective in treating keloids, which occur when a raised scar becomes excessively large and extends beyond the size of the original wound. These scars are more common among patients with darker skin types with an incidence of 4.5 percent to 16 percent in the African-American and Hispanic- American populations.
One such laser, the pulsed dye laser, has been shown to be effective in removing redness, flattening and improving the itching and burning sensations that can occur in raised scars. Two or more treatments every few months may be required to completely revise these scars.
Another option for treating keloids is the use of Immune Response Modifiers (IRMs) following surgical treatment to remove these scars. These topical agents enhance the skin’s ability to identify, control or destroy infections, bacteria and other foreign objects in the body responsible for illness. Following surgery, the application of IRMs induce the production of interferon in the skin, which is an anti-inflammatory agent. The interferon can normalize the skin’s wound-healing function, thereby preventing a keloid from returning following treatment.
“Keloids can be disfiguring and tender with pain and burning, and can be psychologically challenging for the individuals affected by them,” said Dr. Alster. “Both lasers and IRMs offer hope to those individuals who struggle with these scars.”
“Patients should seek help early if they are concerned about their appearance or have a skin condition that is making them self-conscious,” stated Dr. Alster. “A dermatologist can assess a scar, review treatment options with the patient and select the most effective therapy that will maximize results.”
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.