After any injury on the skin, a person has a memorable sign in the form of a scar, which means “scar” in German. Sometimes these marks do not cause problems, as they are either not in a visible place, or are almost indistinguishable from neighboring areas of the skin. But there are situations when the scars are too noticeable, convex, dark, sometimes with a strongly 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. Getting rid of them is not so easy, because this type of scar has a special fiber structure that is difficult to correct.
Types of scars
In some people, wounds heal quickly and almost painlessly. For others, this process stretches 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 (mobile area orno), on the size and depth of damage, on the individual ability of the organism to regenerate, on the type of skin, and so on. The combination of all these reasons leads to the fact that in some cases the scars are as if sunken (they are called atrophic), and in others they are at the same level as the skin (normotrophic).
The most problematic, from the standpoint of cosmetology, are hypertrophic scars. They appear when fibroblasts in the healing tissues of the wound become too active and begin increased collagen synthesis. At the same time, the enzyme collagenase, which destroys excess collagen, is produced in insufficient quantities. As a result, too much new tissue is formed. There is nowhere for the excess to go, and they protrude over the healed injury site. The height of such scars can reach 10 mm. Their color is generally darker than the skin in adjacent areas, and the surface is often rough.
Keloids
These formations look very similar to hypertrophic scars, but have a number of unpleasant differences. The main thing is that keloid scars, having appeared at the site of injury, grow to intact areas of the skin. The trigger mechanism for them can be either 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 a month or more after the wound has healed. Growth can last up to two years, after which the stabilization stage begins. Histological studies in keloids reveal tooactive giant fibroblasts continuously producing collagen. And if hypertrophic scars, although ugly, are painless, then keloids can cause itching, pain, and increased skin sensitivity. There are false keloids that appear at the site of injury, and true ones that occur where the skin is not damaged externally.
Treatment of keloid and hypertrophic scars
Today, the following methods of correction of rough scars are used:
- compression;
- silicone preparations (plates, gel);
- laser therapy;
- surgery;
- radiotherapy;
- cold treatment;
- drug therapy;
- corticosteroids.
Each of them has its advantages and disadvantages. Which of the methods to apply, in each case, the doctor must decide. It is necessary to remove hypertrophic, and even more so keloid scars, which are often diagnosed as dermatofibroma and even infiltrating cancer, only in specialized clinics.
Surgery
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 takes place in 80-90% of all registered cases and manifests itself in the formation of scar tissue even larger than before removal. In the case of hypertrophic scars, the percentagecomplications are slightly lower. Surgical correction is best tolerated by narrow scars with clear edges. During the operation, the surgeon excises them, matches the edges of the incision, makes an internal suture, which is hardly noticeable. This operation is performed under local anesthesia. No hospitalization required.
If extensive scars, such as burn scars, are removed by surgical intervention, patchwork of the skin (graft) is done.
Compression
Hypertrophic scars are practically not corrected by this method, but in the case of keloids, 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 it 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 stops. 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 all over the world. Removal of hypertrophic scars, keloids and other formations on the skin is carried out by the so-called Bucca rays (X-rays using ultra-precise beta applicators). As a result, fibroblasts are destroyed or stop their growth, collagen synthesis stops. Beams of different intensities can be used.
In any case, 90% of them are absorbed by the upper layers of the skin, and only 10% enter the dermis. Often this method is used in conjunction with surgical removal of the scar. Relapses after such therapy were registered in 50% of cases. In view of the peculiarities of exposure to x-rays, the method is not used to remove scars in the head, neck, and chest. Contraindications:
- oncology;
- diabetes mellitus;
- diseases of the heart and blood vessels;
- exacerbation of various diseases.
Cryotherapy
This is one of the safest and most effective methods. Keloids without recurrence with the help of cold completely disappear in 51% of cases. And in 76% of cases, hypertrophic scars are removed. Treatment should be complex (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 the impact on the scar with liquid nitrogen (temperature is about -196 ° C). It is applied with a swab or a special applicator. As a result, ice crystals are formed in the cells, the cytoplasm and organelles die. Thus, fibroblasts are destroyed, collagen synthesis stops. Nitrogen exposure lasts a maximum of 30 seconds, but most often 5 seconds is enough. To completely remove the scar, several procedures are sufficient. Disadvantages of the method:
- painfulness of the procedure;
- possibility of blister formation at the site of the scar;
- hyperpigmentation after treatment.
Treatment with silicone
Pharmaceutical companies have now developed gels containing silicone and special silicone sheets. PrincipleThe actions of the preparations are approximately the same - they serve to maximize the hydration and softening of the body of the scars, blocking the access of oxygen to its fibers and reducing the synthesis of collagen.
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 dense adhesion 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 long-acting (long-acting) corticosteroids fulfill these desires of patients, and good results are also achieved in the treatment of keloids. To date, the corticosteroids "Kenalog" and "Diprosan" are used. The mechanism of their action is approximately the same and consists in reducing the number of leukocytes and cytokines, suppressing the growth factor and growth necrosis, inhibiting the work of fibroblasts, removing allergic reactions, and reducing the level of collagen. The procedure is carried out 1 time in 10-14 days. Side effects:
- hypopigmentation;
- appearance of a network of capillaries on the skin;
- appearance of steroidblackhead;
- thinning skin;
- general negative impact 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 in conjunction with cryotherapy.
Laser therapy
Laser resurfacing of a hypertrophic scar or keloid gives the maximum effect. The essence of the procedure is to carefully and very accurately remove the top 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 decreases, it is practically compared with the surrounding integument. After applying this method, hypertrophic scars completely disappear in 80-95%, and keloid scars - in 60-70% of cases. Complications after the procedure:
- edema;
- hyperemia;
- increased skin sensitivity to sunlight;
- erythema;
- hyperpigmentation (resolves without treatment);
- acne;
- cyst formation.
Laser exposure can be ablative (deeper) and non-amblative (more gentle). In the second case, there are usually fewer complications, but the duration of treatment is longer.
Drug therapy
There is an external treatment and by introducing medicine into the body of the scar. For injections, preparations based on hyaluronidase are used (an enzyme due to which hypertrophic scars becomeless edematous, soft, their relief is flattened). These include Lidaza, Alidaza, Longidaza, Vilidaza and others. Injections should be done every day or every 2 days for 1-2 weeks. Disadvantages of the method:
- enzyme instability;
- adverse reactions;
- allergenicity.
For external treatment, ointments, creams, sprays are used. Pharmacies have a wide range of preparations that remove scars. The most popular are Contractubex, Dermatix, Kelo-Kot, Kelobibraza. The advantages of the method are its ease, the possibility of being treated at home, and the absence of side effects. Disadvantages - low efficiency.
Ointments and injections do not help much against keloid scars, and only complex treatment is carried out.
How to avoid rough scars
If the wound is too big, then the scar will remain one way or another. But in some cases, you can try to minimize its appearance. So, a hypertrophic scar after the removal of a mole is almost never formed if the procedure is performed by cryotherapy, electrocoagulation, using a laser. If the mole is surgically removed, the scar always remains. And when you remove it yourself, at home, an inflammatory process may begin, which will further aggravate the situation.
For any injury to the skin, in order for the wound to heal better and faster, you must follow some rules:
- avoid getting dirt on injured skin;
- avoid rubbing and touchingto the wound surface (for example, clothing);
- never peel off the resulting crusts;
- cover the wound from direct sunlight;
- use special creams that help with rapid healing and reduce the risk of scars (one of the best among such drugs is Contractubex).
