Scar, hypertrophic scar and keloid management

Scars follow any healing process in the body. The skin is an external organ therefore the resultant scar is a blemish on it. On the face scars can be conspicuous. Scars can follow healing as result of trauma, infections eg. Chickenpox etc. The position of these scars occur at random unlike scars as result of plastic surgery where the surgeon makes every attempt to conceal it or places them in a direction that is favourable and easily camouflaged in congruence to wrinkles and folds on the face. Normal scars are amenable to revisional surgery if they are stretched, unsightly, depressed, elevated or unfavourably positioned. Surgical revision is usually followed by some form of scar management.

The diagnosis of hypertrophic scar is usually made when the scar is elevated and can be symptomatic with pain and itch, but the thickening is confined to the original borders of the scar. These naturally improve over time as the scar tissue matures. The maturation process can be speeded up by scar management with the use of oils, creams, pressure taping, silicone sheet or gel application and laser administration.

Keloid scars on the other hand are difficult to treat. Patients that form keloids have a predisposition to forming abnormal scars. Keloids are commoner in the pigmented race group and have a predilection to occur in certain sites of the body. Treatment is orientated around the control of the condition involving a multimodality approach. These include repetitive intralesional steroid, or chemotherapeutic agent injections. This is usually followed by surgical excision. A cure rate of about 60% is achieved. With the addition of postsurgical immediate radiotherapy the cure rate can be increased to about 90%. In the event of a recurrent keloid the use of radiotherapy is mandatory. Scar management similar to the control of hypertrophic scar should be used in the postoperative period to enhance the management.