Pronounced skin pigmentation Certain localization of initial lesions (deltoid muscle area, chest, earlobe) Pregnancy Puberty.
Pathomorphology
Histological examination reveals elongated convoluted bundles of eosinophilically stained hyalinized collagen, thinning of the dermal papillae and decreased elasticity of the fibers. Morphological basis
consists of excessively growing immature connective tissue with a large number of atypical giant fibroblasts that have been in a functionally active state for a long time. IN
keloids
few capillaries, mast and plasma cells.
Keloid: Signs, Symptoms
Clinical picture
Pain Soreness Hyperesthesia Itching Hard, smooth scars raised above the surface of the skin with clear boundaries At the beginning of the disease, there may be pallor or slight erythema of the skin The scar occupies a larger area than the original damage Even after years
continue to grow and can form claw-like outgrowths.
Symptoms of keloid scars
Keloid and hypertrophic scars are accompanied by redness (hyperemia) and pain after pressing on the scar. In this place, the tissues are highly sensitive. The scars begin to itch. Keloids develop in two stages:
- Active is characterized by the dynamic growth of keloid tissue. This is accompanied by itching, numbness of the affected areas and tissue soreness. This stage begins with epithelization of the wound and lasts up to a year.
- During the inactive period, final scar formation occurs. It is called stabilized, acquiring normal skin color. The resulting scar does not cause concern to the owner, but on open areas of the body it looks unaesthetic.
There are two types of keloids. True ones rise above the skin and have a whitish or pink color. The scars are dense, with a smooth shiny surface with a minimal content of capillaries.
The formation of keloids is accompanied by the following symptoms:
- hyperemia (redness) in the scar area;
- painful sensations when pressing;
- increased sensitivity in the area of affected tissues;
- itching when scratching.
The development of keloids goes through two stages - active and inactive.
During the active stage, dynamic growth of keloid tissue occurs, which causes physical discomfort in the patient: itching, soreness and/or numbness of the affected tissues. This stage begins from the moment of epithelization of the wound and can last up to 12 months.
The inactive stage ends with the final formation of the scar. Such a keloid is otherwise called stabilized, since its color resembles the natural color of the skin, and the scar itself does not cause much concern, except for its unaesthetic appearance, especially on open areas of the body.
Keloid: Diagnosis
There are true (spontaneous) and false keloids.
Differential diagnosis
Hypertrophic scars Dermatofibroma Infiltrating basal cell carcinoma (confirmed by biopsy).
Conservative treatment
Keloid scar - how to get rid of it with conservative treatment? First, a diagnosis is made and a biopsy is prescribed to exclude a malignant neoplasm.
Treatment begins with conservative techniques. They help well if the scars are not yet old, formed no more than a year ago.
During compression, pressure is applied to the affected area. The growth of the keloid is stopped by compression. The nutrition of scar tissue is blocked, its blood vessels are compressed. All this helps stop the growth.
Ointment for keloid scars is only an auxiliary method. It is rarely used as an independent remedy. Ointments are usually prescribed as additional drugs that have antibacterial, anti-inflammatory and blood circulation-restoring effects.
Various techniques are used for cosmetic correction of acne keloid: dermabrasion, peelings. All of them are aimed at changing the appearance of scars.
Mesotherapy and other cosmetic methods are carried out only for the upper skin layer, in order to avoid the growth of connective tissue. Correction is indicated only for old scars.
In other cases, three main conservative methods are most often used to remove them. The first way to remove a keloid scar is treatment with silicone plates.
They begin to be used immediately after the first wound healing. Silicone sheets are mainly indicated for people who have a tendency to form keloids.
The essence of the technique is based on squeezing capillaries. As a result, collagen synthesis decreases and tissue hydration ceases. A special patch with plates is used daily for 12-24 hours. The course of therapy is from 3 to 18 months. Compression is a variation of this method.
Second method: treatment of keloid scars with corticosteroids is indicated for local use. An injection is made into the bulge, which includes a suspension of triamcinolone acetonide. It is allowed to inject from 20 to 20 milligrams of the drug per day, 10 mg is spent on each scar.
The purpose of the injections is to reduce collagen production. At the same time, the division of fibroblasts that produce it decreases and the amount of collagenase increases.
Treatment is most effective for non-old scars. In this case, small doses are sufficient for therapy.
After a month, the course of treatment is repeated until the scars are even with the surface of the skin.
The third main method of how to get rid of keloid scars is called cryodestruction. This is a destructive effect on scar tissue with liquid nitrogen. As a result, a crust appears on the treated area.
Healthy tissue forms underneath. After the process is completed, the crust falls off on its own, leaving an almost imperceptible mark. The cryodestruction method is effective only for new keloid and hypertrophied scars.
Aggressive removal of keloid scars is done in two ways - surgically or using a laser. In the first case, during the operation, not only the overgrown tissue is excised, but also the affected area of skin.
The surgical method has its drawbacks - there is a high probability of the formation of new keloid scars.
This risk is somewhat reduced by removing the affected area of skin. However, relapses occur in 74-90 percent of cases. Surgery is indicated only in cases where conservative treatment has proven ineffective.
With the help of laser therapy, keloid scars that minimally affect the surrounding tissue are removed or cauterized. Correction is used in complex treatment and combined with corticosteroid and local methods. With laser therapy, relapses are much less common - 35-43 percent.
Treatment of keloid on the ear occurs according to a certain scheme. First, diprospan or kenologist-40 is prescribed.
Injections are made into the scar tissue. A month after the start of treatment, laser therapy using Bucca rays is performed.
The patient wears a special compression clip on the ear (at least 12 hours daily).
At the end of therapy, phono- and electrophoresis with collagenase or lidase is prescribed to consolidate the effect. At the same time, ointments and gels are prescribed (Lioton, Hydrocotisone, etc.).
If after this the growth of scar tissue does not stop, then close-focus radiotherapy is added to the treatment. In severe and complex cases, methotrexate is given.
A keloid scar after a cesarean section can be treated in many ways. In some cases, deep chemical peeling can help get rid of keloid scars.
First, the scar is treated with fruit acids. After this, chemicals are applied.
This method is ineffective, but also the most cost-effective.
For the treatment of keloid scars after removal of a mole or cesarean section, plates and gels containing silicone are prescribed. There are many anti-scar products with a collagenase base.
Hyaluronidase preparations are used. Hormone-based products with vitamins and oils help eliminate keloid scars.
To remove mature scars, physiotherapy is prescribed: phonoelectrophoresis. These are effective and painless procedures. In extreme cases, plastic surgery or laser resurfacing is done. A more gentle method is microdermabrasion. During the procedure, microparticles of aluminum oxide are used.
There are many ways to treat keloid scars using traditional methods. The scars are not completely removed, but they become less visible.
Plant-based products are used. For example, take 400 g of sea buckthorn oil and mix it with 100 g of beeswax.
The solution is heated in a water bath for 10 minutes. Then a gauze pad is dipped into the mixture and applied to the scar.
The procedure is carried out twice a day. The course of treatment is three weeks.
To remove scars, compresses are made with camphor, in which the bandage is moistened. Then it is applied to the scar. The compress is done daily for a month. Only after this will the result be visible.
You can make a tincture from delphinium. The roots of the plant are greatly crushed. Alcohol and water are added to them, mixed in equal proportions. The container is removed for two days in a dark place. Then a gauze pad is soaked in the liquid and applied to the keloid scar.
You can make your own ointment based on Japanese styphnolobia. A couple of glasses of plant beans are crushed and mixed with badger or goose fat in equal proportions.
The mixture is infused for 2 hours in a water bath. Then, at intervals of a day, it is heated twice more.
After this, the mixture is boiled, stirred and transferred to a ceramic or glass jar.
Keloid scars do not pose a threat to health or life, but can cause nervous disorders due to the unaesthetic appearance of the body. In the early stage, neoplasms are much easier to treat than in the advanced version.
According to statistics, keloid scars are not very common - only 10 percent of cases. Women are most susceptible to this disease. To prevent scars, you must follow all doctor's instructions and not self-medicate.
The nature of keloid is not fully understood, so to date no universal treatment method has been developed. The doctor chooses the methods individually for each patient, depending on the clinical picture of the disease.
Treatment methods can be divided into conservative and aggressive (radical).
It is preferable to start with conservative ones, especially if the scars are young - no older than one year. Three methods are recognized as the most effective:
- use of silicone coating/gel;
- corticosteroid injection therapy;
- cryotherapy.
Application of silicone plates
You should start using silicone plates in the form of a patch immediately after the initial healing of the wound in people who are predisposed to the development of keloids.
The mechanism of this technique is based on squeezing capillaries, reducing collagen synthesis and hydration (moistening) of the scar. The patch must be used from 12 to 24 hours a day.
The treatment period is from 3 months to 1.5 years.
A variation of this treatment method can be considered compression (squeezing), as a result of which the growth of the keloid stops, nutrition is blocked and the vessels of the scar are compressed, which leads to a stop in its growth.
Corticosteroid injections
This technique is used locally. A suspension of triamcinolone acetonide is injected into the scar using an injection.
You can administer 20-30 mg of the drug per day - 10 mg for each scar. Treatment is based on reducing collagen synthesis.
At the same time, the division of fibroblasts that produce collagen is inhibited, and the concentration of collagenase, the enzyme that breaks down collagen, increases.
Treatment in small doses is effective for fresh keloid scars. After 4 weeks, the treatment is repeated until the scars are compared with the surface of the skin. If there is no therapeutic effect, a triamcinolone suspension containing 40 mg/ml is used.
Treatment with steroids can cause complications:
Treatment
Lead tactics
Local injections of HA are most effective. Pressure on the damaged area prevents the development of
Bandages are used that create a pressure of up to 24 mm Hg over the injury site. Art. , for 6–12 months. The bandage can be removed for no more than 30 minutes/day. Radiation therapy in combination with GC - if other treatment methods are ineffective.
Surgery
indicated only for extensive lesions and ineffectiveness of local treatment with GC. A high frequency of relapses is noted, so surgical treatment is recommended no earlier than 2 years after formation.
with immediate preventive treatment (as with emerging
Drug therapy
On one day, the drug can be injected into 3 scars (10 mg for each scar) The needle should be inserted in different directions for better distribution of the drug The effectiveness of the method is higher with fresh keloid scars Treatment is repeated every 4 weeks until the scars are compared with the surface of the skin If there is no effect, you can use triamcinolone suspension containing 40 mg/ml for surgical excision.
keloids
You can use a mixture of triamcinolone solution (5–10 mg/ml) with local anesthetics. To prevent relapses after surgery, injections of HA into the area of scar excision after 2–4 weeks and then 1 time per month for 6 months.
Course and prognosis
Under the influence of triamcinolone
decrease over 6–12 months, leaving flat, light scars.
ICD-10 L73. 0 Acne keloid L91. 0 Keloid scar.
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Prevention
To reduce the risk of relapses after surgical operations to remove a keloid, it is customary to carry out preventive measures already in the process of forming a new scar (on days 10-25).
All therapeutic (conservative) methods are used as preventive measures. After surgery, you should constantly use sunscreen with a high level of protection.
Currently, there are no specific methods for treating scar changes on the uterus. Obstetric tactics and the preferred method of delivery are determined by the condition of the scar zone, the characteristics of the gestational period and childbirth. If an ultrasound scan has determined that the fertilized egg has attached to the wall of the uterus in the area of the postoperative scar, the woman is recommended to terminate the pregnancy using a vacuum aspirator. If the patient refuses an abortion, regular monitoring of the condition of the uterus and developing fetus is ensured.
Independent childbirth with a uterine scar is recommended for women with one previous cesarean section performed through a transverse incision. Mandatory conditions for choosing natural delivery are uncomplicated pregnancy, the consistency of scar tissue, normal functioning of the placenta and its attachment outside the area of scar changes, cephalic presentation of the fetus, and its correspondence to the size of the mother's pelvis. In such cases, the pregnant woman is hospitalized at 37-38 weeks of pregnancy for a comprehensive examination. To improve the prognosis with the onset of labor, the prescription of antispasmodics, antihypoxic and sedative drugs, and agents to improve fetoplacental blood flow is indicated.
For patients at high risk of recurrent rupture, operative delivery is recommended. Direct indications are:
Longitudinal scar. The probability of divergence of scar tissue after dissection of the uterine wall in the longitudinal direction is several times higher than with transverse incisions.
Presence of more than one scar. If a woman has had more than one cesarean section, the pregnancy is completed surgically.
Some gynecological interventions. Conservative myectomy of a node on the posterior wall of the uterus, reconstructive plastic surgery for abnormalities of the uterus, and surgery for cervical pregnancy are contraindications to natural childbirth.
Previously suffered uterine rupture. If the previous birth was complicated by a rupture of the uterine wall, the next pregnancy is completed by cesarean section.
Scar failure. If diagnostic signs of predominance of coarse fibrous connective tissue in the scar area are detected, surgery is performed.
Pathology of the placenta. Surgical delivery is indicated for placenta previa or its location in the area of scarring.
Clinically narrow pelvis. The loads that arise during the passage of a fetus whose size does not correspond to the woman’s pelvis, as a rule, provoke a re-rupture.
If, during spontaneous labor, a woman in labor with a scar on the uterus is in danger of rupture, a caesarean section is performed as an emergency. After surgery, the uterine wall defect is sutured. Extirpation of the uterus is carried out only in cases of extensive damage with the impossibility of suturing or the occurrence of massive intraligamentary hematomas.
A keloid scar (ICD 10) is a scar formation that forms on the area of the affected skin. The damage must be treated, otherwise marks may remain for life. A keloid scar also indicates the rapid healing of destroyed skin tissue.
Keloid scar according to ICD 10 code is classified as a physiological phenomenon. This is the result of restoration of artificially deformed tissues. Often, scars heal and become invisible, but keloid scars have a distinct character and appearance.
A keloid is a dense growth that may externally resemble a tumor, characterized by the following features:
- The scar is located outside the damaged area. Grows in a horizontal direction.
- A keloid is a cicatricial scar characterized by acute pain and itching. A striking example is the feeling of skin tightening.
- If over time it becomes practically invisible, then the colloidal one does not change color or size. This occurs because blood vessels grow inward.
Causes and symptoms of formation
Even minor skin defects lead to the formation of painful scars. Among the main reasons are:
- Self-treatment of wounds. If the edges of the incision are not connected correctly, the skin becomes deformed and illness cannot be avoided. This mistake can also be made by a doctor.
- Keloid appears as a consequence of an infectious infection. Disinfection and the use of appropriate products are a prerequisite for safe wound treatment.
- As confirmed by the ICD 10 code, it is formed after too much tension on the skin during suturing. This spoils the appearance initially and subsequently becomes a destructive factor.
- Medical examinations identify keloids as a result of hormonal imbalance. Among the causes is immunodeficiency.
The international classification of the disease takes into account hereditary predisposition. The abundance of scars in relatives may indicate a high probability of the formation of a keloid scar.
Possible complications
The international classifier does not recognize keloids as dangerous diseases that constitute a threat and lead to serious complications. This will not cause a future tumor, a malignant formation that poses a risk to life.
Scar removal and modification is initiated for two reasons:
- Aesthetic. Looks unsightly on exposed skin. The scar is not disguised as a tan and when blood vessels grow, it stands out on the body.
- Practical. Scars located on the bend of the joints hinder movement. When wearing tight, tight clothing, discomfort and itching from rubbing occur.
Prevention of occurrence
You can prevent the appearance of a keloid in the following ways:
- Bandages. Special bandages that create strong pressure localize the source of spread. However, not every wound allows the use of such solutions.
- Balanced treatment. A timely visit to a doctor will help disinfect the wound and develop an individual program for recovery. The use of vinegar and other aggressive agents leads to side effects.
- Caution. Do not squeeze out the abscess or massage the scar due to itching. This indicates an inflammatory process, so you should consult a specialist.
- Cold peace. Baths, saunas and high temperatures are contraindicated for patients with keloids.
In most cases, deformation of scars is a consequence of wound infection. If you receive an abrasion or mechanical damage to the skin, the main thing is to consult a doctor in a timely manner, do not put strain on the deformed tissues and do not self-medicate.
The formation of scar tissue is a physiological response to damage to the skin and mucous membranes. However, changes in extracellular matrix metabolism (an imbalance between its breakdown and synthesis) can lead to excessive scarring and the formation of keloids and hypertrophic scars.
Wound healing and hence scar tissue formation involves three distinct stages: inflammation (in the first 48-72 hours after tissue injury), proliferation (up to 6 weeks) and remodeling or maturation (for 1 year or more). A prolonged or excessive inflammatory phase may contribute to increased scarring. According to the results of modern research, in people with a genetic predisposition, first blood group, IV-V-VI skin phototype, scar formation can develop under the influence of various factors: IgE hyperimmunoglobulinemia, changes in hormonal status (during puberty, pregnancy, etc.) .
A key role in the formation of a keloid scar is played by abnormal fibroblasts and transforming growth factor - β1. In addition, keloid scar tissue exhibits an increase in the number of mast cells associated with increased levels of fibrosis promoters such as hypoxia-inducible factor-1α, vascular endothelial growth factor, and plasminogen activator inhibitor-1.
In the development of hypertrophic scars, the main role is played by disruption of the metabolism of the extracellular matrix of newly synthesized connective tissue: overproduction and disruption of the remodeling processes of the intercellular matrix with increased expression of collagen types I and III. In addition, disruption of the hemostatic system promotes excessive neovascularization and increases the time of re-epithelialization.
There are no official figures for the incidence and prevalence of keloids and hypertrophic scars. According to modern research, scar formation is observed in 1.5-4.5% of individuals in the general population. Keloid scars are detected equally in men and women, more often in young people. There is a hereditary predisposition to the development of keloid scars: genetic studies indicate autosomal dominant inheritance with incomplete penetrance.
Classification of skin scars:
There is no generally accepted classification.
Clinical picture (symptoms) of skin scars:
The following clinical forms of scars are distinguished:
- normotrophic scars;
- atrophic scars;
- hypertrophic scars:
- linear hypertrophic scars;
- widespread hypertrophic scars;
- small keloid scars;
- large keloid scars.
There are also stable (mature) and unstable (immature) scars.
Keloid scars are well-defined, dense nodules or plaques, pink to purple in color, with a smooth surface and irregular, indistinct borders. Unlike hypertrophic scars, they are often accompanied by pain and hyperesthesia. The thin epidermis covering the scars is often ulcerated, and hyperpigmentation is often observed.
Keloid scars form no earlier than 3 months after tissue damage, and then can increase in size for an indefinitely long time. As they grow like pseudotumors with focal deformation, they extend beyond the boundaries of the original wound, do not regress spontaneously, and tend to recur after excision.
The formation of keloid scars, including spontaneous ones, is observed in certain anatomical areas (earlobes, chest, shoulders, upper back, back of the neck, cheeks, knees).
Hypertrophic scars are dome-shaped nodes of various sizes (from small to very large), with a smooth or bumpy surface. Fresh scars have a reddish color, later it becomes pinkish and whitish. Hyperpigmentation is possible along the edges of the scar. Scar formation occurs within the first month after tissue damage, and an increase in size occurs over the next 6 months; Scars often regress within 1 year. Hypertrophic scars are limited to the boundaries of the original wound and, as a rule, retain their shape. Lesions are usually localized on the extensor surfaces of joints or in areas subject to mechanical stress.
Diagnosis of skin scars:
The diagnosis of the disease is established on the basis of the clinical picture, the results of dermoscopic and histological examinations (if necessary).
When carrying out combination therapy, consultations with a therapist, plastic surgeon, traumatologist, and radiologist are recommended.
Differential diagnosis
| Keloid scar | Hypertrophic scar |
| Infiltrating growth beyond the original lesion | Growth within the original damage |
| Spontaneous or post-traumatic | Only post-traumatic |
| Predominant anatomical areas (earlobes, chest, shoulders, upper back, back of the neck, cheeks, knees) | No predominant anatomical sites (but usually localized to extensor surfaces of joints or areas subject to mechanical stress) |
| Appear 3 months or later after tissue damage, may increase in size indefinitely | They appear within the first month after tissue damage, can increase in size within 6 months, and often regress within 1 year. |
| Not associated with contractures | Associated with contractures |
| Itching and severe pain | Subjective sensations are rare |
| Skin phototype IV and above | No connection with skin phototype |
| Genetic predisposition (autosomal dominant inheritance, localization on chromosomes 2q23 and 7p11) | No genetic predisposition |
| Thick collagen fibers | Thin collagen fibers |
| Absence of myofibroblasts and α-SMA | Presence of myofibroblasts and α-SMA |
| Type I collagen > type III collagen | Type I collagen< коллаген III типа |
| Overexpression of COX-2 | Overexpression of COX-1 |
Treatment of skin scars:
Treatment Goals
- stabilization of the pathological process;
- achieving and maintaining remission;
- improving the quality of life of patients:
- relief of subjective symptoms;
- correction of functional deficiency;
- achieving the desired cosmetic result.
General notes on therapy
Hypertrophic and keloid scars are benign skin lesions. The need for therapy is determined by the severity of subjective symptoms (eg, itching/pain), functional impairment (eg, contracture/mechanical irritation due to the height of the formations), as well as aesthetic indicators, which can significantly affect quality of life and lead to stigmatization.
None of the currently available scar treatment methods in the form of monotherapy allows achieving scar reduction or improving the functional state and/or cosmetic situation in all cases. Almost all clinical situations require a combination of different treatment methods.
Drug therapy
Intralesional administration of glucocorticosteroid drugs
- triamcinolone acetonide 1 mg per 1 cm 2 intralesional (with a 30-gauge needle 0.5 inches long). The total number of injections is individual and depends on the severity of the therapeutic response and possible side effects. Intralesional administration of triamcinolone acetonide after surgical excision of the scar prevents recurrence.
- betamethasone dipropionate (2 mg) + betamethasone disodium phosphate (5 mg): 0.2 ml per 1 cm 2 intralesional. The lesion is punctured evenly using a tuberculin syringe and a 25-gauge needle.
Non-drug therapy
Cryosurgery
Liquid nitrogen cryosurgery results in complete or partial reduction of 60-75% of keloid scars after at least three sessions (B). The main side effects of cryosurgery are hypopigmentation, blistering and delayed healing.
The combination of cryosurgery with liquid nitrogen and injections of glucocorticosteroid drugs has a synergistic effect due to a more uniform distribution of the drug as a result of intercellular edema of scar tissue after low-temperature exposure.
Scar treatment can be carried out using the open cryospray method or the contact method using a cryoprobe. Exposure duration – at least 30 seconds; frequency of use – once every 3-4 weeks, number of procedures – individually, but not less than 3.
- Carbon dioxide laser.
Scar treatment with a CO 2 laser can be carried out in total or fractional modes. After total ablation of a keloid scar with a CO2 laser as monotherapy, relapse is observed in 90% of cases, so this type of treatment cannot be recommended as monotherapy. The use of fractional laser treatment modes can reduce the number of relapses.
- Pulsating dye laser.
The pulsed dye laser (PDL) produces radiation at a wavelength of 585 nm, which corresponds to the absorption peak of red blood cell hemoglobin in blood vessels. In addition to its direct vascular effects, PDL reduces the induction of transforming growth factor-β1 (TGF-β1) and the overexpression of matrix metalloproteinases (MMPs) in keloid tissues.
In most cases, the use of PDL has a positive effect on scar tissue in the form of softening, reduction in erythema intensity and standing height.
Surgical correction of scar changes is accompanied by relapse in 50-100% of cases, with the exception of keloids of the ear lobes, which recur much less frequently. This situation is associated with the peculiarities of the surgical technique, the choice of method for closing the surgical defect, and various options for plastic surgery with local tissues.
Radiation therapy
Used as monotherapy or adjunct to surgical excision. Surgical correction within 24 hours after radiation therapy is considered the most effective approach for treating keloid scars, significantly reducing the number of recurrences. Relatively high doses of radiation therapy over short exposure times are recommended.
Adverse reactions of ionizing radiation include persistent erythema, skin peeling, telangiectasia, hypopigmentation and the risk of carcinogenesis (there are several scientific reports of malignant transformation following radiation therapy of scars).
Requirements for treatment results
Depending on the method of therapy, positive clinical dynamics (reduction in scar volume by 30-50%, reduction in the severity of subjective symptoms) can be achieved after 3-6 procedures or after 3-6 months of treatment.
If there are no satisfactory treatment results after 3-6 procedures / 3-6 months, modification of therapy is necessary (combination with other methods / changing the method / increasing the dose).
Prevention of skin scarring:
Persons with a history of hypertrophic or keloid scars, or those who are undergoing surgery in an area at increased risk of their development, are advised to:
- For wounds with a high risk of scarring, silicone-based products are preferred. Silicone gel or sheets should be applied after the incision or wound has epithelialized and continued for at least 1 month. For silicone gel, a minimum of 12 hours daily use or, if possible, continuous 24 hours use with hygienic treatment twice daily is recommended. The use of silicone gel may be preferable when the affected area is large, when used on the face, and for persons living in hot and humid climates.
- For patients with an average risk of developing scars, it is possible to use silicone gel or sheets (preferably), hypoallergenic microporous tape.
- Patients at low risk of developing scars should be advised to follow standard hygiene procedures. If the patient expresses concern about the possibility of scar formation, he may use silicone gel.
An additional general preventative measure is to avoid exposure to sunlight and use sunscreens with a maximum sun protection factor (SPF > 50) until the scar matures.
Typically, the management of patients with scars can be reviewed 4-8 weeks after epithelialization to determine the need for additional interventions to correct the scars.
IF YOU HAVE ANY QUESTIONS ABOUT THIS DISEASE, CONTACT DERMATOVENEREOLOGIST KH.M. ADAEV:
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Rough scars on the face or body today no longer adorn real men and, especially, women. Unfortunately, the capabilities of modern medical cosmetology do not allow us to completely get rid of scar defects, only offering to make them less noticeable. The process of scar correction requires persistence and patience.
“Run” and “scar” are synonymous words. Scar is a common, everyday name for a scar. Scars on the body are formed due to the healing of various skin injuries. Exposure to mechanical (trauma), thermal (burns) agents, skin diseases (post-acne) lead to disruption of the physiological structure of the skin and its replacement with connective tissue.
Sometimes scars behave very insidiously. With normal physiological scarring, the skin defect shrinks and turns pale over time. But in some cases, scarring is pathological: the scar becomes bright purple in color and increases in size. In this case, immediate assistance from a specialist is necessary. The problem of scar correction is dealt with jointly by dermatocosmetologists and plastic surgeons.
Scar formation.
In its formation, the scar goes through 4 successively replacing each other stages: I - stage of inflammation and epithelization.It takes from 7 to 10 days from the moment the injury occurs. Characterized by a gradual decrease in swelling and inflammation of the skin. Granulation tissue is formed, bringing the edges of the wound closer together; there is no scar yet. If infection or divergence of the wound surface does not occur, the wound heals by primary intention with the formation of a barely noticeable thin scar. In order to prevent complications at this stage, atraumatic sutures are applied that spare tissue, and daily dressings are performed with local antiseptics. Physical activity is limited to avoid divergence of wound edges. II - stage of formation of a “young” scar.
Covers the period from the 10th to the 30th day from the moment of injury. It is characterized by the formation of collagen-elastin fibers in granulation tissue. The scar is immature, loose, easily extensible, bright pink in color (due to increased blood supply to the wound). At this stage, secondary wound trauma and increased physical activity should be avoided. III - stage of formation of a “mature” scar.
Lasts from the 30th to the 90th day from the date of injury. Elastin and collagen fibers grow into bundles and line up in a certain direction. The blood supply to the scar decreases, causing it to thicken and turn pale. At this stage there are no restrictions on physical activity, but repeated trauma to the wound can cause the formation of a hypertrophic or keloid scar. IV - stage of final scar transformation.
Starting from 4 months after injury and up to a year, the final maturation of the scar occurs: the death of blood vessels, tension of collagen fibers. The scar thickens and turns pale. It is during this period that the doctor understands the condition of the scar and further tactics for its correction.
It is not possible to get rid of scars once and for all. With the help of modern techniques, you can only make a rough, wide scar cosmetically more acceptable. The choice of technique and the effectiveness of treatment will depend on the stage of formation of the scar defect and the type of scar. The rule applies: the sooner you seek medical help, the better the result will be.
A scar is formed as a result of a violation of the integrity of the skin (surgery, trauma, burn, piercing) as a result of the processes of closing the defect with new connective tissue. Superficial damage to the epidermis heals without scar formation, i.e. Cells of the basal layer have good regenerative ability. The deeper the damage to the skin layers, the longer the healing process and the more pronounced the scar. Normal, uncomplicated scarring leads to the formation of a normotrophic scar: flat and the same color as the surrounding skin. Disturbance in the course of scarring at any stage can lead to the formation of a rough pathological scar.
Types of scars.
Before choosing a treatment method and the optimal timing of a particular procedure, you should determine the type of scars.Normotrophic scars usually do not cause much distress to patients. They are not so noticeable, because their elasticity is close to normal, they have a pale or flesh-colored color and are at the level of the surrounding skin. Without resorting to radical treatment methods, such scars can be safely eliminated using microdermabrasion or chemical surface peeling.
Atrophic scars can occur due to acne or poor-quality removal of moles or papillomas. Stretch marks (striae) are also this type of scar. Atrophic scars are located below the level of the surrounding skin and are characterized by tissue sagging resulting from decreased collagen production. Lack of skin growth leads to the formation of pits and scars, creating a visible cosmetic defect. Modern medicine has in its arsenal many effective ways to eliminate even fairly extensive and deep atrophic scars.
Hypertrophic scars are pink in color, limited to the damaged area and protrude above the surrounding skin. Hypertrophic scars may partially disappear from the surface of the skin within two years. They are highly treatable, so you shouldn’t expect them to disappear spontaneously. Small scars can be treated with laser resurfacing, dermabrasion, and chemical peeling. Positive results are achieved by the introduction of hormonal drugs, diprospan and kenalog injections into the scar area. Electro- and ultraphonophoresis with conractubex, lidase, and hydrocortisone give a lasting positive effect in the treatment of hypertrophic scars. Surgical treatment is possible, in which scar tissue is excised. This method gives the best cosmetic effect.
Keloid scars have a sharp border and protrude above the surrounding skin. Keloid scars are often painful, and itching and burning are felt at the sites of their formation. This type of scar is difficult to treat, and recurrence of keloid scars of even larger sizes is possible. Despite the complexity of the task, aesthetic cosmetology has many examples of successful solutions to the problem of keloid scars.
Features of keloid scars.
The success of treatment of any disease largely depends on a correct diagnosis. This rule is no exception in the case of eliminating keloid scars. It is possible to avoid mistakes in treatment tactics only by clearly defining the type of scar; in terms of external manifestations, keloid scars often resemble hypertrophic scars. A significant difference is that the size of hypertrophic scars coincides with the size of the damaged surface, while keloid scars extend beyond the boundaries of the injury and can exceed the size of the traumatic skin damage in area. Common places for keloid scars to occur are the chest area, ears, and less commonly, joints and the face. Keloid scars go through four stages in their development.Epithelization stage. After injury, the damaged area is covered with a thin epithelial film, which within 7-10 days thickens, becomes rough, becomes pale in color and remains in this form for 2-2.5 weeks.
Swelling stage. At this stage, the scar enlarges, rises above the adjacent skin, and becomes painful. Over the course of 3-4 weeks, the painful sensations weaken, and the scar acquires a more intense reddish color with a cyanotic tint.
Compaction stage. The scar thickens, dense plaques appear in some places, and the surface becomes lumpy. The external appearance of the scar is a keloid.
Softening stage. At this stage, the scar finally acquires a keloid character. It is pale in color, soft, mobile and painless.
When choosing treatment tactics, they are based on the age of the scars. Keloid scars from 3 months to 5 years of existence (young keloids) are actively growing, are distinguished by a smooth shiny surface, red in color with a cyanotic tint. Scars older than 5 years (old keloids) turn pale and acquire a wrinkled, uneven surface (sometimes the central part of the scar sinks).
Keloid scars can be caused by surgical interventions, vaccinations, burns, insect or animal bites, or tattoos. Such scars can occur even without traumatic injury. In addition to significant aesthetic discomfort, keloid scars give patients unpleasant sensations of itching and pain. The reason for the development of this particular type of scars, and not hypertrophic ones, has not yet been established by doctors.