There are many ways to treat scarring, which are generally divided into non-surgical treatment, surgical treatment, and comprehensive treatment in medicine.
Non-surgical treatment includes: laser, compression therapy, radiation, medication, rehabilitation and other treatment methods.
Surgical treatment includes: scar excision, fractionated and stratified excision, post-excision skin slice and/or flap graft repair, laser or surgical grinding, tissue expander application, etc.
Combined treatment includes: post-surgical supplementation with medication, laser or photon, radiation or isotope therapy, compression therapy, medication, closure with physical therapy, etc.
Each of these methods has its own advantages and disadvantages, and the scope of application is different. If once scarring occurs, how to choose from so many methods? You must not act rashly, but consult an experienced doctor to make a clear diagnosis before choosing.
I. Drug treatment of scar
There are many drugs for the treatment of scarring, the most commonly used in clinical practice is the direct local application of scarring.
1. Steroids: The route of medication is mainly local injection (such as tretinoin, etc.) or preparation into creams or ointments for application and patching within the scar. It is suitable for hyperplastic scar and keloid with obvious effect. Due to the effect of the drug itself, or too large injection dose, incorrect method, different individual sensitivity of patients, etc., local or systemic side effects may occur after using the drug, such as: local capillary dilation, pigmentation, loss of pigmentation, mild local skin depression, menstrual disorders in women, etc.
2.Silicone preparations: the most commonly used ones are Mepi, scar enemy, silicone cream, scar paste, etc., which are easy to use, simple and without local discomfort or slight discomfort. It is suitable for post-operative or early post-burn applications. In addition to this, Chinese herbal preparations in China have their own characteristics to inhibit scar itching, such as scar itching ointment.
It is especially important to emphasize that there are various topical drugs for scar treatment, which can accelerate the softening and degradation of the scar, but cannot completely eliminate it. Some drugs advertise that they can completely eliminate the scar and remove the scar completely, which is not credible. Patients should not waste money and energy and increase their psychological burden by seeking medical help in a hurry.
Pressure therapy for scarring
The method of preventing scar proliferation and treating hyperplastic keloid scars and keloids by applying continuous pressure to the scar area with elastic fabric (elastic sleeve, elastic garment, elastic bandage, etc.) is called compression therapy. Compression therapy has been used for over 100 years to treat skin scars. The principle of action is that pressure narrows the vascular lumen in the scar and reduces blood flow, resulting in a lack of nutrients in the scar tissue and a significant inhibition of scar tissue proliferation, thus achieving the goal of treating the scar.
This method is simple and easy to use, with almost no side effects, and can also be used as an adjunct to surgery, laser, medication, radiation and other treatments, which can reduce the dosage of medication and recurrence rate. This method is suitable for patients with various sizes of hyperplastic scars or those who are not suitable for radiotherapy or local drug treatment.
Laser and photorejuvenation (intense pulsed light) therapy for scarring
Laser and IPL are the latest scar treatment methods developed in recent years, with different emphasis on different kinds of scar treatment. Firstly, for superficial old depressed scars (e.g. post-surgery, post-trauma, chicken pox, and acne residue), fractional laser and ultra-pulsed CO2 laser grinding treatments can be chosen, which can bring significant improvement after one to several sessions. Secondly, for hyperplastic keloids, laser can be chosen to close the blood vessels to slow down the growth and shrink the collagen tissue, and then close the scar with medication to stop the growth and flatten it. For post-surgical fresh wound scars, photorejuvenation (intense pulsed light) is preferred and can quickly calm and slow down the onset of hyperplasia. It works well in conjunction with other treatments.
For example, depressed scarring left after acne can be treated with multiple dermal grinding techniques or fractional techniques to remove the epidermis from the scarred portion, creating a trabecular surface and simultaneously stimulating growth at the base of the scar. At the same time, combined with the topical application of biological products such as fibroblast growth factor and epidermal growth factor, the growth of fibrous tissues and skin epidermis is promoted, and the depressions are eventually filled in to achieve good cosmetic results. For larger areas of the face, eat liquid food for 3 days after dermabrasion, and change the dressing in the early postoperative period, which can grow well in 4-7 days if no infection occurs. The newly grown traumatic skin is red and young, so pay attention to protection, you can apply sunscreen to prevent skin dryness and cracking or pigmentation color.
Radiation therapy for scarring
Radiation can penetrate human tissue. When it irradiates scar tissue, its radiation energy is transmitted to the tissue, causing physical and chemical damage to the scar, thus inhibiting and destroying the growth of the scar and achieving the purpose of treating the scar. In the early days, strong penetrating X-rays were applied to directly irradiate the keloid, but the effect was slow and the side effects were large. Nowadays, it has been improved to apply beta radiation that only irradiates superficial layers after the keloid or hyperplastic scar is removed, which shortens the treatment time and also greatly reduces the side effects.
Radiation therapy is indicated for the treatment of abnormal scarring and is usually used as an adjunctive therapy to prevent recurrence after surgery. Individual patients have mild local reactions after irradiation, and even develop radioactive dermatitis and radioactive ulcers, so further comprehensive treatment is required. Radiation therapy is not recommended at present.
V. Role of physiotherapy in scar treatment
Physiotherapy is a method of treating scar tissue by using natural and artificial physical factors such as electricity, light, sound, cold and heat, etc. It is referred to as physical therapy. It includes: light therapy, electrotherapy, hydrotherapy, heat therapy, ultrasound therapy, etc. In the process of wound healing, scar recovery and scar treatment, appropriate physical therapy can be selected according to the need to prevent the formation of scar, soften the formed scar, promote scar treatment, such as reducing the local symptoms of tightness, pulling, dryness, pain and itch, and improving the local function with good effect.
Sixth, surgical excision of scar or partial scar followed by skin grafting or flap trauma repair, scar release, scar reshaping, dilator placement, expanded flap transfer repair, etc.
Except for some superficial scars, which generally do not require treatment, all other types of scar tissue require treatment due to varying degrees of contracture and dysfunction. Scarring of the face and neck, in addition to producing deformity and dysfunction, can also affect the appearance and cause mental and psychological burden to the patient. Hand scarring can cause hand dysfunction. Scar contracture in other parts of the body can also affect the normal activities of individual limbs or joints.
All types of scar contractures with functional impairment require treatment. Some scars that do not produce contracture symptoms but cause persistent itching or pain, or frequently break down, should also be considered for excision and repair. Surgical excision should be considered for smaller areas of proliferative scars that interfere with functional activities or form deformities, especially on the face and hands.
Fine plastic surgery can make obvious, ugly scars tiny and inconspicuous. For mature and stable scar tissues, surgical excision can be used for treatment, and finally the scar can be treated by skin grinding or medical laser grinding, which will eventually lead to satisfactory results.
VII. Significance of rehabilitation therapy in scar treatment
Rehabilitation therapy for scar treatment is also known as rehabilitation training, which mainly includes physical therapy method, medical exercise therapy and compression therapy. Proper, timely and correct rehabilitation training can improve the function of respiratory, circulatory, digestive and metabolic systems through the regulation of nerves and body fluids throughout the body, and improve the patient’s mood, which is no less important for patients whose severe and large scar formation leads to disfigurement and dysfunction, affecting normal work and daily life, and even causing psychological imbalance and mental depression. It can not only soften the scar, but also regulate the physiological functions of the human body and restore the quality of the human body, including muscle strength, exercise endurance, flexibility of joint activities, body reaction and balance coordination. It can also regulate the patient’s mentality through exercise and build up the confidence to be positive and overcome the disease.