Scars on the skin: treatment and prevention of education
Scars on the skin( scars) are coarse fiber strands consisting of connective tissue.They are formed on sites that have been damaged.Fresh scars have a red or pink color.Old scars can be hypo- or hyperpigmented, i.e., either lighter or much darker than healthy skin.
Scars are regarded as cosmetic defects, and most people try to get rid of them as much as possible.To eliminate scars, a number of conservative and radical measures have been developed - from the use of ointments and creams to surgical excision.One of the options for eliminating scar scarring on the skin are local injections of steroid hormones.The correction process requires patient patience;It is not always possible to completely eliminate the scars, but it is quite realistic to make them unobtrusive.Table of contents: How and why are scars formed on the skin?Types of scars How to get rid of scars?What are keloid scars?
How and why do scars form on the skin?
The cause of the formation of scars is this or that skin damage.Most often these are chemical or thermal burns, deep cuts( wounds) and skin pathologies( for example - acne).Noticeable scars remain after many surgical interventions.In the injured areas, the healing process proceeds, during which the normal tissue is replaced by a connective tissue.
The process of scar formation includes 4 consecutive stages:
- restoration and epithelialization;
- formation of a "young" rumen;
- formation of a "mature" rumen;
- final transformation.
The first stage lasts from 1 to 1.5 weeks from the time of the damage.Post-traumatic inflammation and puffiness gradually subside, a granulation tissue is formed in the wound, and the edges of the defect begin to gradually approach each other.If there is no divergence and the wound does not get an infection, then the healing takes place with a primary tension.
The second stage lasts up to 1 month from the time of injury.At this stage, granulation forms connective tissue( elastin and collagen) fibers, forming a loose scar.It is characterized by a bright pigmentation due to increased blood supply to the affected area.
The duration of the third stage is up to 3 months.The fibers are organized, that is, they are combined into directed beams.The scar on the skin tightens and begins to turn pale.In this phase, it is important to avoid accidental re-injury, since it can lead to keloid formation.
The final transformation lasts up to a year.The scar ripens, which is accompanied by the tension of connective tissue fibers and the death of the vessels.Normally, the color becomes much less bright.Only at this stage it is possible to draw conclusions about the condition of the scar and draw up a further treatment plan.
General and local factors influencing the speed and character of scar formation:
- age( the regeneration rate decreases with aging);
- immune status;
- hereditary factors( in particular - the activity of fibroblasts);
- damage localization;
- type of injury;
- vastness of wound or burn surface.
Note: Damage to the outer layer of the skin proceeds without the formation of scar tissue, as the basal cells of the epidermis are characterized by a high degree of ability to regenerate.The deeper the damage, the longer the healing takes place and the scar is more noticeable.
Types of scars
There are 3 main types of scars on the skin:
- is hypotrophic;
- are hypertrophic.
Normotrophic are on par with the surrounding healthy skin, the hypotrophic ones are slightly retracted, and the hypertrophic ones rise above the surface of the .
Normally the defect pale and retracts with the passage of time, and with a pathological process of scarring the scar acquires a bright pigmentation( becomes dark purple), and its dimensions sometimes increase.
Color of normotrophic scars bodily or pale, and elasticity - almost like a healthy skin.They, as a rule, do not cause special concern to patients.It is quite easy to get rid of such scars;For this, surface chemical peeling or microdermabrasion( mechanical grinding of the upper layers of the skin) is used.
Atrophic defects are more likely after acne or after a violation of the technology of removal of benign skin lesions.In the process of their formation, the process of collagen biosynthesis is disrupted, so a tissue of flabby consistency is formed.Currently, a number of effective methods for eliminating atrophic scars have been developed.
Note: refers to so-called "stretch marks"( striae) to atrophic scars.
Hypertrophic scars on the skin differ in color from surrounding tissues - they are bright pink or purple.For several years, these defects may become less pronounced, but medical and cosmetic procedures can significantly accelerate this process.
If the area of hypertrophic scars on the skin is small, chemical peeling, mechanical or laser resurfacing is shown.The effectiveness of injections into the defective area of steroid hormone preparations( Kenalog, Hydrocortisone and Diprospan) was proved effective.To get rid of such scars help physioprocedures - ultra- and electrophonophoresis with enzymes, hormones and other special preparations( for example-Kontraktubeksom).
How to get rid of scars?
Important: treatment should be performed only under the supervision of a physician.Self-medication, based on the advice of acquaintances, at best will not yield any results, and at worst - scars on the skin will become only more noticeable and ugly.
Now in pharmacies it is possible to freely purchase gels Kontraktubeks and Miederma.They are not able to completely eliminate the cosmetic defect, but, certainly, are capable of stimulating the recovery processes.The use of these external preparations ensures the formation of the least noticeable normotrophic scar.
To improve the general condition of the skin, it is advisable to apply cosmetic products to it with retinol( vitamin A) and fruit acids.
To prevent the pigmentation of the scar, it should not be exposed to ultraviolet .In clear weather, scarring and skin around it is strongly recommended to protect with sunscreen or cover with clothing.
Physiotherapeutic procedures improve microcirculation and stimulate the formation of granulations and connective tissue fibers.To accelerate the regeneration, phonophoresis is widely used.It involves the introduction of drugs into the deep layers of the skin with the help of ultrasonic radiation.The hardware effect of additional tissue heating and micromassage, which stimulates metabolic processes.The useful compounds delivered during the procedure are deposited, and then spread through the body with blood flow.Phonophoresis allows you to reduce swelling as soon as possible.Another effective hardware method of treatment is electrostatic massage.With the help of vibrations created by an alternating electrostatic field, it is possible to significantly improve local blood flow.
Photo correction is a kind of masking of the scar.Under the influence of a beam of light, excessive pigmentation disappears, and the scar becomes almost the same color as the healthy skin nearby.The procedure is indicated for all types of scars.Depending on the severity of the defect, a different number of procedures are required to achieve a noticeable positive result( usually within 10).
The essence of laser resurfacing is that the directional radiation quickly and bloodlessly evaporate thin layers of connective tissue.Laser exposure is used in conjunction with other therapeutic methods.
Cryotherapy assumes a local effect on the defect by low temperatures with the help of a special applicator through which liquid nitrogen is fed.The procedure does not apply if the patient has swarthy skin, as it causes local depigmentation.
Above 90% of the scars can be eliminated or made less visible by injecting hydrocortisone directly into the defect zone.The disadvantage of the method can be considered a local pigmentation of the skin, but it spontaneously disappears with time.If the scars are atrophic, then injections of hyaluronic acid help.
Peeling is used to stimulate the regenerative processes and remove dead cells.The procedure stimulates the synthesis of elastin and collagen, smoothing and lightening of the scars on the skin.
Dermabrasion is a mechanical grinding.Atrophic scars can be exposed to this effect at an early stage, and keloid and hypertrophic scarring - only after the scar tissue is fully formed.
In case of hypertrophic defect redistribution, 10 surface chemical peeling procedures are first performed, and then 5-7 deep-exposure sessions to stimulate reparative processes.To prevent overdrying and inflammation is additionally shown on the skin application of a special cream with silicone.
Large hypertrophic scars on the skin are subject to surgical correction( excision).The connective tissue is removed, and the edges of the new wound are formed.They are tightened by an intradermal suture, and as a result, the normotrophic scar is gradually formed.After surgery, galvano- and phonophoresis with preparations for fibrinolysis( enzyme hyaluronidase and heparin) is shown.At the next stage of treatment, peelings with fruit acids and vitamin A. are shown to the patient.
The effectiveness of radiotherapy in the treatment of keloids has been scientifically proved, but the radiation in general has too many side effects to use it to eliminate aesthetic flaws.
What are keloid scars?
Separately, keloid scars should be considered.They are characterized by the presence of clearly delineated boundaries and an elevation above the skin of the .Patients often complain of local soreness, itching and burning in the areas where the keloid tissue was formed.Scars of this kind are the hardest to get rid of, but in a number of cases the problem can be safely solved.
The occurrence of keloids is noted after the introduction of vaccines( in particular against smallpox), animal or insect bites, burns and surgeries.Until now, it has not been established reliably why the skin develops keloid rather than hypertrophic scars.One of the leading causes is infection of the wound.
The most frequent localization of keloid defects is the auricles, chest and areas in the projection of the joints.
Note: keloid is a tumor-like proliferation of coarse-fibrous connective tissue.
Scarring is formed in 4 stages.
- Initially, epithelialization occurs - the wounding of the injured area with a thin film, which coarsens, stiffens and pale for 1-1.5 weeks.This condition of the scar is preserved up to 2.5 weeks.
- Then begins swelling, during which the tissue begins to protrude above the surface of the skin, and the scar becomes painful.In the coming month the intensity of unpleasant sensations decreases, but the scar acquires a reddish-cyanotic color.
- The next step is the compaction, and the appearance on the surface of the scar of individual dense plaques with a bumpy surface.
- At the softening stage, the scar turns pale and becomes softer.Its tissue is mobile and completely painless.
To determine the tactics of treatment, it is important to differentiate atrophic and keloid scars.Outwardly they are similar in many respects, but the sizes of the first clearly coincide with the borders of the wound or burn, and the area of the second often exceeds the area of the injured surface.
In addition, the prescription of scarring on the skin is always taken into account.It can be installed in appearance.Young keloids( 3 to 5 years from the time of injury) have a bright pigmentation and a shiny smooth surface, and the old ones are uneven, wrinkled and pale;Their central section often falls.
If the keloid variety is diagnosed, it is advisable to use cryotherapy, which helps to flatten the scar.
In order to prevent their occurrence, with extensive and / or deep damages, it is necessary to apply for qualified medical care, and as soon as possible to consult a plastic surgeon .The main task of outpatient treatment is to eliminate suppuration, i.e., secondary bacterial complications.To prevent an infectious and inflammatory process, daily( in some cases repeated) treatment of skin lesions with an antiseptic solution and the application of a sterile dressing are necessary.
Even if the size of the wound is small, but its edges tend to divergence, you should immediately contact a surgeon who will apply a cutaneous suture and a constrictive bandage.If the period of keloid formation does not exceed 6 months, a special silicone plate will help reduce its severity.To make the scar less noticeable, you can use a resorption plaster.
Plisov Vladimir, medical reviewer