Newswise — There are many reasons for a surgical procedure, including the diagnosis or removal of skin cancer. Regardless of the reason or type, whenever a patient undergoes surgery, there will be a resulting scar. Though a natural part of the body's healing process, scars can be unsightly reminders which make people feel self-conscious, particularly if the scar is located on exposed skin. Today, thanks to new advances, dermatologists are finding better ways to keep surgical scars from leaving their mark.
Speaking today at the 64th Annual Meeting of the American Academy of Dermatology, dermatologist James M. Spencer, M.D., M.S., clinical professor of dermatology at Mount Sinai School of Medicine in New York City, discussed types of scars, treatments and common scar treatment myths.
"Both an individual's age and the location of the scar on the body or face affect the way a scar forms," said Dr. Spencer. "Younger skin makes strong repairs, but can overheal causing a thicker scar, and scars on tighter skin will seem more visible. Whatever the type, thanks to new research, we're finding improved ways to minimize the appearance of surgical scars."
Types of ScarsThere are several different types of scars: atrophic scars, hypertrophic scars and keloids. Atrophic scars are skin depressions or indentations. They can be a result of surgery, but more often result from medical conditions such as acne. Hypertrophic scars and keloids are elevated above the skin. Hypertrophic scars have a tendency to become thick and appear swollen. They wounds usually take longer to heal and the scars remain within the bounds of the original wound. Treatment is important during the healing phase to improve the cosmetic appearance of this type of scar.
"Patients with darker skin types have a higher incidence of developing hypertrophic scars and keloids," said Dr. Spencer. "Studies have shown an incidence rate of 4.5 percent to 16 percent in the African-American and Hispanic-American populations."
Keloids are similar to hypertrophic scars, but keloids are much more aggressive. Keloids form because both skin cells and connective tissue cells, or fibroblasts, begin multiplying excessively to repair the damage to the skin. The fibroblasts continue to multiply even after the wound is healed, causing the scar to swell and widen beyond the original mark.
Scar TreatmentsTwo new treatment methods that are beneficial in minimizing the appearance of surgical scars are the use of a pulsed-dye laser and topical application of the Immune Response Modifier (IRM), imiquimod. The pulsed-dye laser uses a yellow, high-energy light to remove scar redness and flatten hypertrophic scars and keloids. This also can improve the itching and burning sensations that accompany some scars.
"With the pulsed-dye laser, patients can return to work or regular activity within one week, though the treated skin may remain pink for several weeks," said Dr. Spencer. "While this treatment can be used with any type of scar, hypertrophic scars or keloids typically need two or more treatments every one or two months."
IRMs enhance the skin's ability to identify and control or destroy certain viral infections in the skin by stimulating cytokine production in the skin. Cytokines are naturally occurring proteins used by immune system cells to communicate with each other. When IRMs stimulate the cytokines, cell immunity is enhanced and the body is able to more efficiently control or eliminate virus-infected cells.
"Imiquimod stimulates one of the skin's naturally occurring inflammatory agents, interferon, which can affect the skin's wound-healing function," said Dr. Spencer. "Using this topical agent on scar sites after surgery may help produce a smaller scar."
Myths about Scar TreatmentsOver the years, there have been many different treatments for scars. With continued research, some of these treatments have been proven ineffective. Among those are two topical treatments: topical vitamin E and onion extract.
Though many people have used vitamin E to attempt to improve the appearance of scars, studies have shown that there is no benefit and in some cases, its use may actually worsen the scar's appearance. Additionally, many people can develop contact dermatitis to vitamin E.
Many people believe that the onion extract acts as an anti-inflammatory and will inhibit the over production of collagen in a scar. In fact, a recent study on a topical treatment with onion extract showed that it was no more effective than other over-the-counter treatments.
"Scars can be disfiguring and emotionally disturbing," said Dr. Spencer. "With so many treatment options available, it is important that patients work closely with a dermatologist to identify the treatment that will be most beneficial for their scars."
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 15,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or http://www.aad.org.
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