Topical treatments:
Topical treatments include vitamin E creams, gels and oils that claim to help fade the color of prominent scars. These are extensively used and an enormous number of such products are widely available both in pharmacies and online, with some successful anecdotal results reported. However, a double-blinded study undertaken on 15 patients with scars following cancer surgery suggested that there was no evidence for the efficacy to the cosmetic outcome of vitamin E products and that it might even make some scars worse. Of the patients studied, 33% developed a contact dermatitis to the vitamin E. In addition, the Mayo Clinic grades the evidence on scars and vitamin E as grade D, which means there is fair scientific evidence against this use (suggesting it may not work).
Chemical peels:
Peels in scar treatment have focused mainly upon acne scar treatment, although they may be used for any type of scar which has an element of hypertrophy, where the aim is to lower the scar to be flush with the skin. Examples would include scars created after burns, surgery or trauma, but not scars that are depressed. Trichloroacetic acid (TCA) peels and salicylic acid peels are frequently used and tend to be combined with other treatments such as micro needling and laser. There appears to be no consensus on the best combination, if any, of these elements of treatment, with many practitioners offering their own blend or package.
Corticosteroid injections:
Corticosteroid injections are a mainstay of treatment for hypertrophic scars and keloids. Usually triamcinolone is injected in multiple small aliquots along the length of the wound, or, if practical, a linear infiltration technique is used. The result is a reduction in redness of the scar and then slowing of growth, followed in most cases by regression of the bulk of the lesion.
Silicone sheets:
Silicone gel sheets, which can be placed on scars to encourage moisture accumulation under the scar to hydrate the skin, have also been shown to be effective for some scars and have led to a wide range of versions being made available for patients to purchase for themselves for self-treatment. Research has suggested they are safe and effective, and also well tolerated for the treatment of hypertrophic and keloid scars.
Dermal fillers:
Fillers are particularly suited to a couple of applications, namely pitted scars and acne scarring, such as ice pick scars. When combined with subcision,8 fillers can produce a cosmetically effective result. A single treatment can therefore provide both components of the treatment i.e. the subcision with the needle bevel, followed by the insertion of the filler material through the same needle to fill the space created by the subcision. This is an example of when a needle is more effective than a cannula as the latter cannot be used for subcision. The filler needle’s bevel can be inserted below the defect or ice pick scar and moved from side to side in an arc to divide the tissue, anchoring the base of the scar down to the subcutaneous tissue. Injecting the filler material, usually hyaluronic acid, will fill the defect from below and raise the surface of the scar to be consistent with the surrounding tissue, thus reducing its visibility for the life of the filler, which may last between to four to nine months depending on the product. Furthermore, the production of new collagen is stimulated in the same way as micro needling, which may lead to more permanent filling of the defect by the patient’s own tissue. Other types of filler materials such as calcium hydroxyapatite may be more effective for this latter function.
Micro needling:
Micro needling therapy, also called collagen induction therapy (CIT), and percutaneous collagen induction (PCI), involves making large numbers of punctures into the scarred area using needles which can generally range from 0.5mm to 3mm in depth. The devices used can be pen-like or needle encrusted rollers, used under topical anesthesia. The punctures are repaired by the body’s natural healing process of skin proliferation producing collagen and elastin to plug the wounds, which can reduce the appearance of the scar. This treatment is used for most types of scar.
