Scars & keloids
________Dr. Mohan Rangaswamy________
Scars
A scar is a visible mark due to previous injury or surgery. Any type of injury to the skin that is deep enough to breach the second layer of skin [called dermis] will usually result in a scar. There are a lot of myths and misconceptions about scar formation, appearance, and relationship to age of the person and even about plastic surgery and scar. The five important myths are given below.
Myth 1: Plastic surgery can be done without scar
Fact 1 : Any cut on the skin will always leave a scar. Plastic surgeons pay special attention to scar location, direction, technique of wound closure and after-care to ensure the best possible and least visible scar.
Myth 2: Plastic surgery can erase scars and make them go away
Fact 2 : Plastic surgery cannot make scars go away; it can make the scar better, fainter, possibly make it fall into a better line and direction and make it fainter.
Myth 3: Children heal well and don’t form scars
Fact 3 : Except in the foetus and possibly in the first few days after birth, children form bad scars. From age 2-14 they have strong scar forming tendency although they heal fast. Best scars are formed by persons over 50 years age.
Myth 4: Plastic surgeon can make fine almost invisible scar in any person
Fact 4 : The most important factor in scar appearance is the racial type and skin type of the patient. Skin has been classified into 6 Fitzpatrick types; generally speaking, the best scars are seen in type 1 and the worst in types 5,6 [in terms of color, visibility and fading of scar]. The next important factor is the surgical technique, age and scar direction w.r.t certain lines of the body called RSTL lines. Even within a given race/skin type different individuals form different types of scars with identical surgery done by the same surgeon. Bottom line: Appearance of scars are multi-factorial and a bit unpredictable.
Myth 5: Scars can be erased by laser
Fact 5 : Laser and IPL are very useful in treating scars and helping them to ‘fade’ but cannot make them ‘disappear’.
Thick scars [Hypertrophic]
Normal time course of most fresh scars is that they worsen for about 3 months and then start improving. Stable end result can be seen in 1-2 years.
However, persons with bad scar tendency react differently. In them the scar continues to worsen month after month so that an initial fine scar gradually becomes a horrible thick itchy red/dark broad line. This if it persists beyond 6 months, is called a hypertrophic scar.
Q: Who is prone to this?
Ans: If you have a family history of bad scars or belong to black or eastern-oriental races, the tendency is very strong.
Q: What can be done?
Ans: It needs aggressive multi-modal treatment by laser, IPL, compression garments, silicone sheets, steroid injections etc. done under care of a plastic surgeon. Sometimes the scar will have to be ‘revised’ or surgically removed and the wound closed by improved techniques followed by all of the above.
Q: Is hypertrophic scar same as keloid?
Ans: NO. Keloid is a more severe condition – see below.
Keloid
It is a condition where a thick scar forms on a site of injury or even without clear-cut injury but where the scar spreads and involves nearby skin as well. So it grows sideways to involve more and more area. It causes intense itching and pain It can get infected or develop pits with ingrown hairs which in turn lead to infection; infected keloids are very painful. The sufferer may not even tolerate contact with the clothes or seat belt. Thus keloids can cause considerable suffering to the victim.
Common sites are: front of chest, shoulder, back and ears.
Treatment is difficult and unpredictable. Nevertheless, considerable and sometimes dramatic relief can be provided by judicious use of special treatment techniques. Injection of locally acting steroid into the lesion is the main-stay of therapy. These injections can be painful but can be made painless with extra care. Dr.Mohan uses special technique to make this almost painless. Several patients who have formerly shied away from injection treatment have been convinced to continue the full course of 6-8 sessions after experiencing the painless therapy here.
Other treatments such as pressure therapy, laser, and silicone tapes are also prescribed; the patient will be guided fully by the doctor and his staff.
Most insurers do not cover keloid treatments!! Reason: Standard Exclusion!! This is an area where the insurance providers need to revise their rule book since keloids truly cause suffering and are not merely a cosmetic issue.