Scars

Scars are marks on the skin that result from the normal healing of wounds caused by accidents, diseases, surgeries or other abnormal changes to the skin. The more skin damage that occurs and the longer it takes to heal, the greater the chance of an obvious scar. However, some people may develop a visible scar after experiencing mild injury or inflammation.

WHAT DOES A SCAR LOOK AND FEEL LIKE?

Scars often appear red and somewhat thick at first and then slowly fade to light pink or white. New scars may be tender, itchy or painful. The pain usually goes away with time. Scars may end up raised above the skin’s surface or depressed below the skin’s surface. They may be darker or lighter than the skin around them once they heal. Scars also can appear as stretched skin, which usually occurs when the skin is under tension while healing. It may take many months — perhaps more than a year — for a scar to fade.

WHY DOES MY SCAR LOOK THE WAY IT DOES?

The way your scar looks can be affected by your age, sex, race, health and lifestyle, including sun exposure. Other factors include the type of injury and its severity, the presence of infection, and the location of the wound on the body. Wounds on the chest or on body parts where the skin pulls in many directions, such as the knees or upper back, tend to result in thicker and more visible scars.

Sometimes too much inflammation (how red or swollen the wound is) during healing may lead to hypertrophic scars or keloids. Hypertrophic scars are thickened or raised scars that form from excess scar tissue. Keloids are tough, irregularly shaped raised scars that grow larger than the size of the initial wound. Keloids are more common in people with darker skin types.

HOW CAN I MAKE MY SCAR LESS NOTICEABLE?

It is not possible to fully remove a scar. However, there are many treatments that can improve the look of a scar, sometimes to the point that it is barely noticeable. Treatment can change the size, depth or color of the scar.

An important first step in the treatment of scars is to see a board-certified dermatologist and explain what bothers you most about your scar. Your dermatologist will inspect your scar to decide what can improve it. Together you will decide the best treatment.

Most scars can be treated in the dermatologist’s office. Only severe scars, such as burns over a large area of the body, may need surgeries that require general anesthesia or a hospital stay.

WHAT TREATMENTS DO DERMATOLOGISTS OFFER?

The type of treatment you receive in a board-certified dermatologist’s office depends on your scar. Your dermatologist may combine multiple treatments to get the best results. Treatment options include:

• CORTICOSTEROID INJECTIONS

Corticosteroid shots can treat hypertrophic scars and keloids. They soften the scar tissue and cause the scar to shrink and flatten. If your dermatologist recommends corticosteroid shots, you may need many shots, given at intervals.

• LASER AND LIGHT TREATMENTS

These procedures use focused-energy laser light to minimize the appearance of both raised and depressed scars. There are many different types of laser and light procedures available to address scars. A board-certified

dermatologist can advise you on what’s most appropriate based on the desired effect, such as improving the scar’s color or texture.

Both ablative and nonablative lasers can be used to treat scars.

Ablative lasers penetrate the skin, removing areas of tissue or creating tiny zones of injury. As the treated tissue goes through the natural healing process, the scar’s appearance
Nonablative lasers enhance the natural healing process without damaging the skin’s surface. This type of laser can be used to reduce redness and hyperpigmentation, and to improve scar texture.

Your dermatologist will decide the type of laser or light device best suited for your scar and the number of treatments you will need. Depending on the type of procedure, some people can return to work or regular activity immediately, but others may need to wait up to a week. Your skin may stay pink for a few days to a few weeks. It is important to protect the scar from the sun during the healing process, as ultraviolet light can interfere with healing and cause the treated skin to darken.

• SURGICAL EXCISION

Under certain circumstances, your dermatologist may cut out your scar and reattach the surrounding skin. The goal is to make a new, thinner scar that is less visible. This surgery may be an excellent treatment for older scars because the skin around the scar will have had time to stretch. It also may be a good option for scars that are wide or long, are in prominent places (such as the face), or have healed in an obvious pattern or shape. The results of excision depend on your skin’s ability to regenerate (renew itself) over time.

• SOFT TISSUE FILLERS

Soft tissue fillers may be used alone or combined with excision or other surgeries. These injectable substances help raise depressed scars. The dermatologist injects the filler into the depressed scar to fill the space and smooth the surface of the skin.

Although this treatment can fill in a depression, it will not alter the appearance of the scar on the skin’s surface. While the improvement may be immediate, it is not permanent. You will need to repeat the injections. Different fillers last for varying times. Your dermatologist will help you decide which filler is best for your scar.

• 5-FLUOROURACIL AND BLEOMYCIN

When injected into a thick, raised scar, these medicines can help soften and flatten the scar and improve its overall look. In some cases, the treatment may shrink the scar. This procedure is a safe and effective option for treating hypertrophic scars and keloids. It also can relieve scar itching and pain.

• CRYOSURGERY

This treatment uses liquid nitrogen to freeze the scar. Freezing stimulates formation of collagen, tissue that helps keep the skin firm. In turn, this results in a flatter, more even scar. The procedure is often used to treat hypertrophic scars and keloids.

Common short-term side effects of cryotherapy include pain during and/or shortly after treatment, blisters, and swelling in the treated spot. The most common long-term problems are new scars and discolored skin at the treatment site.

• CHEMICAL PEELS

These procedures involve the use of a chemical to remove the top layer of the skin. This can give the skin a more

even color or texture. Chemical peels can be helpful for shallow, superficial scars on the face.

Many peeling chemicals are available. Different chemicals go to different skin depths to treat different types of scars. Superficial (light) peels tend to need a short healing time, while deeper peels can require up to two weeks to heal. How often you will need to repeat peels will depend on the type and depth of the peel. It could range from weekly to monthly.

• DERMABRASION

Dermabrasion can treat minor acne scars, pockmarks (depressed scars from diseases like chickenpox) and some surgical scars. With a handheld electrical device, the dermatologist abrades (removes) the top layers of your skin to smooth the surface. You must cover the treated spot until new skin forms. Most patients can return to work within a week. Treated skin often stays pink for a few weeks or months.

Your dermatologist will advise you on how many treatments are needed. If your scars are minor, you will likely need just one or a few treatments. For larger or major scars, such as deep acne or surgical scars, you will likely need at least a few treatments. Dermabrasion may occasionally result in some loss of normal skin color in the treated area.

treatment

• MICRONEEDLING

Microneedling involves puncturing the skin with thin needles to create tiny wounds, causing the skin to heal itself and improving the appearance of scars. While there are some at-home microneedling devices on the market, they cannot deliver the same results as an in-office treatment from a board-certified dermatologist. Talk to your dermatologist to see if microneedling is a good option for you. Multiple sessions may be necessary, and your dermatologist may combine the procedure with another treatment, such as topical medication.

ARE THERE NONPRESCRIPTION TREATMENTS FOR SCARS?

• PRESSURE THERAPY

Pressure dressings such as bandages and stockings can flatten some types of scars if you use them each day for a few months. You also can buy special pressure earrings for earlobe scars without a prescription. Your dermatologist will tell you if your scar may improve with pressure bandages or earrings.

• SILICONE GEL

Sheets and ointment containing silicone gel can flatten and soften thickened scars, such as burn scars. They also may relieve pain and itching. To get results, you must use these treatments every day for at least two to three months. Before using silicone treatment, visit your dermatologist to confirm the scar is completely healed and ready to be treated.

• POLYURETHEANE DRESSINGS

These moist, flexible sheets can reduce the appearance of raised scars. When worn after surgery, they may

prevent the formation of a raised scar.

• OTHER TREATMENTS FOR SCARS

There are other nonprescription scar remedies available to purchase in stores and online. Some of these products may contain onion extract or vitamins A and E. However, there is limited research available about the effectiveness of these ingredients. Speak with your board-certified dermatologist before using these treatment options.

WHAT ABOUT SKIN CARE AFTER SCAR TREATMENT?

Dermatologists advise that you apply sunscreen before and after scar treatment. This is because newly formed skin is very sensitive to damage from ultraviolet radiation. In addition, protecting scars from UV light can prevent them from becoming darker and more visible. Your dermatologist can help you select the right sunscreen for you.

Applied correctly, makeup can cover scars as nature completes your healing after treatment. It also can hide redness that occurs after laser resurfacing, dermabrasion and chemical peels on the face. Ask your dermatologist before using makeup on a scar, as you may not be able to apply makeup for a period of time after some treatments. You also may want to consult a makeup expert for the right color combination to hide redness and other color changes from the scar.

A board-certified dermatologist is a medical doctor who specializes in the diagnosis and medical, surgical and cosmetic treatment of skin, hair and nail conditions. To learn more about scars or to find a board-certified dermatologist in your area, visit aad.org/scars or call toll-free (888) 462-DERM (3376).

Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

American Academy of Dermatology

P.O. Box 1968, Des Plaines, Illinois 60017AAD Public Information Center: 888.462.DERM (3376) AAD Member Resource Center: 866.503.SKIN (7546) Outside the United States: 847.240.1280

Web: aad.org

Email: mrc@aad.org