Scar Tissue: Causes, Prevention, and Treatment

Causes of Scar Tissue

• Uncertain Causes: Exact causes of scar tissue formation are not fully understood.
• Hypertrophic Scars and Keloids:
  • Result from burns, insect bites, acne, chickenpox, piercings, tattoos, and surgery.
  • Keloids are more common in people with darker skin.
  • Often occur in people aged 10-30.

Prevention

• Main Strategy: Avoid elective surgery if at risk and treat conditions like acne that may lead to scarring.

Impact of Scars

• Physical Symptoms: Itchiness, pain, and movement restrictions.
• Emotional Impact: Can lead to distress due to appearance.

Treatment Costs

• Scar treatments in the U.S. cost over $20 billion annually.

Treatment Options

• General Note: Not all treatments work for everyone. Doctors need to set realistic expectations.

Topical Treatments

• Onion Extract: Anti-inflammatory properties; inconsistent effectiveness.
• Mitomycin C: Limited effectiveness; used with other treatments.
• Imiquimod: 5% cream, inconsistent results.

Injectable Treatments

• Bleomycin: Reduces collagen; few studies available.
• Interferon: Decreases keloid size; expensive and requires frequent injections.
• Corticosteroids: First choice for keloids; involves multiple injections.
• Botulinum Toxin A: Mentioned but no details provided.

Mechanical Treatments

• Cryotherapy: Uses liquid nitrogen; more effective with other treatments.
• Pressure Therapy: Slight improvements; mechanical pressure reduces blood supply.
• Adhesive Tape: Reduces skin tension; prevents scar formation.

Radiotherapy

• Used post-keloid removal; caution due to cancer risk in chest/neck areas.

Laser Therapy

• Ablative: Flattens scar tissue.
• Nonablative: Disrupts blood supply.
• Effective for surgical and hypertrophic scars.

Silicone Treatments

• Improves scar volume, elasticity, color, and firmness; requires long-term use.

Scar Massage

• Used in burn units; weak evidence but potential benefits for hypertrophic scars.

Considerations

• Lack of Universally Successful Treatment: Different treatments work variably.
• Psychological and Physical Effects: Important to address these alongside physical treatments.
• Patient Awareness: Important to inform about treatment limitations and set realistic expectations.