By Debra Jaliman, MD
Everybody has scars: from childhood injuries, from surgeries, from accidents. They are an inevitable part of life, since we don’t live in a safe bubble. But what most people don’t realize is that scars can be minimized, often to the point of near invisibility.
There are two basic types of scars: hypertrophic, which follow the line of injury, and keloidal, where the scarring spreads to the surrounding tissue, forming large bumps and ridges.
Scars are caused by hyperproliferation of collagen. Some people are more prone to scar formation, for reasons that are not altogether clear. People of African American and Caribbean ancestry tend to develop keloids more than other ethnic groups, but the truth is that no ethnicity is immune to keloids. Some areas of the body are more likely to develop keloids: the chest, the back, the shoulders, and the earlobes, probably because the collagen there is thicker to begin with.
To decrease scarring, proper wound care is essential. Any wound, large or small, has to be kept moist. That’s why my first aid kit at home contains antiobiotic ointment, rather than cream, because ointments keep moisture in. Another useful item to have around is a big jar of Aquaphor Healing Ointment, a petrolatum-based product that is both inexpensive and effective at keeping wounds moist. Clean the wound, apply the ointment, then a bandage. This goes for children’s scratches and grazes, too.
Surgical scars should be treated as soon as the sutures are out. People facing elective surgery or who have scheduled c-sections should buy silicone bandages, which change the temperature of the wound area, decrease oxygen, and improve skin hydration. Silicone bandages must usually be used for at least a couple of months, but the results are worth it. Many doctors also use steroid pills or injections to decrease collagen production. People who know they are prone to keloid formation should absolutely discuss this possibility with their doctor before having any procedure.
Once scars have formed, treatment is still possible. Non-ablative lasers, such as the Medlite and Genesis lasers, do a good job of improving the appearance of scars. It does take several treatments, though, and will cost at least a few hundred dollars. Some doctors use cryotherapy, freezing the scar with liquid nitrogen. But since it may affect the color of the skin, it’s not recommended for those with dark skin. Deep scars may require surgery, where the scar is cut out; the resulting scar is usually smaller and less noticeable.
Aldara (imiquimod) cream also appears to discourage scarring after surgery, so it may be worth asking your surgeon for a prescription before you have the procedure. On the other hand, I’m sorry to say that the vitamin E oil so many people apply to their scars is useless; it won’t make scars worse, but it won’t make them better, either, so don’t waste your money. And finally, radiation treatment should only be used as a last resort, since it carries with it the risk of skin cancer.
Bottom line: Meticulous wound care can result in significantly less scarring.