SCARRING,ASSESSMENT AND TREATMENT

Scarring of skin produces physical, psychological and social consequences.

Deep scarring skin changes can produce major deformities, restriction of movement and function and are caused by loss, distortion or displacement of tissue.

Deep skin changes usually involve the deep fascia, subcutaneous fat and the deep collagenous dermis

Correction of deep scarring may require the use of plastic surgery techniques, whereby tissue is replaced or reduced by various techniques. Deformative scarring may be corrected by several release techniques.

Superficial scarring involves the superficial collagenous dermis and surface epidermal layer which also incorporates pigment cells and may involve superficial blood vessels, nerves, hair and sweat apparatus

Superficial dermal scarring can produce raised or keloid scars, superficial depressions, wrinkling and red vascular changes. Destruction of hair and sweat glands may occur, the latter producing dry and irritable skin. Nerve damage can result in unpleasant skin sensations and in some cases traumatic damage occurs due to lack of skin perception.

Vascular changes seen as excessive redness or obvious blood vessels can be improved using specific laser therapy

Depressive scars can be improved using various filler techniques or by stimulating the body’s repair mechanisms to produce new collagen. Topical derivatives of Vitamin A have been shown to have this property as have some dermabrasion techniques

Overactive, raised or keloid scars can be treated by surgical excision but in many cases medical treatments in the form of injected or topical cortisone preparations can be very useful

Topical silicon preparations can also produce scar diminution

Scarring can be perceived by superficial skin changes alone without deeper structures being involved

Excessive or deficient pigmentation of the skin can ensue due to over stimulation or damage to the skin’s superficial pigment cells

Excessive pigmentation can be decreased by superficially applied preparations such as vitamin A and other preparations or in some cases laser treatment

Deficient pigmentation can be improved by ultraviolet light techniques and in some cases by pigment cell transplantation

Scarring can be particularly traumatic on the face and hands.

The psychological and social impacts of skin scarring are often a major component of injury and addressing these factors should go hand in hand in the therapeutic approach to the treatment of scarring.