Scar formation is a natural part of the healing process that occurs when the skin repairs wounds caused by accident, surgery or disease. Scars are formed by the over production of a naturally occurring chemical in the body called collagen. In the normal healing process, once the wound has healed, collagen stops being produced and the skin returns to normal. The time skin takes to heal will vary depending on the degree of damage, and the longer it takes to heal the greater the chance of a noticeable scar. Normal scars will develop during the first 48 hours after wound closure and can fade within 3 months, whereas abnormal scars can occur up to 18 months later.

Different Types of Scars:



Hypertrophic scars are the most common type of scar and usually follow a trauma such as a burn or accident, or after surgery. Hypertrophic scars will follow the line of the injury, which means it will follow the line of the surgical would, where the burn has been or where the original cut was. Some scars get better on themselves, but if the scar is still red and raised after a couple of weeks then it will need to be treated. Some people prefer to prevent scars forming and there is good evidence that early use of treatments such as silicone gels can prevent hypertrophic scars forming. Hypertrophic scars can be treated with simple non-invasive therapy.

Keloids are found in about 15% of the population and are more prevelant in people with dark (African or Asian) skin. The cause of Keloids is not entirley known, but they usually (but not always) follow an injury. Keloids tend to occur from the age of 10 and 30 and occur mainly on the chest, ear or shoulders. The main way to tell if the scar is hypertrophic or a Keloid is that Keloids extend away from the area of the injury and can be quite large. More than 80% of Keloid patients complain of itching, and 50% complain of pain associated with the Keloid. Treatment is normally complex and best done under the supervision of a specialist. Simple therapies such as silicone gels will help, but there maybe the need for additional treatments.

Burn scars are fromed when the skin is burned on the top layer (superficial burn) or through to the second layer of skin (partial thickness burn). Burns tend to be complicated and are slow to heal. As a result a great many burns end up with scars. If the wound does not heal properly within two weeks then there is a more than 80% chance that a scar will develop. The size of the scar depends upon the size of the burn and tend to be hypertrophic scars but spread over a large area. Burn scars can be treated and tend to be treated under a specalist with several different types of treatment used, including silicone gels.

Atrophic scars are small pitted indentations in the skin. These are usually occur after acne, chicken pox, insect bites or in some cases after injections. The scars are sometimes red but this can fade over time. The redness of atrophic scars can be treated, by simple convenient therapy such as silicone gel, microdermabrasion,microneedle therapy, but the indentation is slightly harder to treat and may require a physical process such as dermabrasion or a chemical peel.

The main causes of scars are:


- Genetic
Some people are just prone to scarring. This can be partly due to skin type, but can be just realted to the fact that some peoples genetic make up, mean they produce too much collagen when they are healing.
- Skin Type
Dark skins (Afro-Caribeean and Asian) tend to scar badly and are particularly susceptible to Keloids. People who burn easily in the skin also tend to scar badly.
- Hormones
Some women develop scars when they are pregnant but not at any other time. Also Keloids, tend to occur during or just after puberty, implying that there is a hormonal link to scar formation
- Size of wound
The larger the wound the more likely you are to develop an abnormal scar. This is related to the time to heal
- Time to heal
It has been proven that the longer the wound takes to heal, the more likely that you are to scar. The time to heal is dictated by the severity of the wound, wound infections, number of dressing changes and how deep the wound is.

Treatment:


The best form of treatment for scarring is prevention and careful management of the wound. Even with the best care possible some people will just scar and will need to treat the scars. If you have a history of scarring or you know someone in your close family that scars, you will need to treat early with therapy such as silicone gels to prevent scars forming

Silicone is recommended by leading specialists worldwide for the treatment and prevention of scars
As can be seen for the different type of scars below, silicone is recommend as first line treatment for scars of all types, sometimes in combination with other therapies.



What to do:
Two weeks after the wound has closed your skin is still fragile and maybe inflamed. However, it is important at this stage to gently moisturise and massage the scarred area with a non-perfumed simple cream. This will ensure that the scar is kept hydrated and encourage the scarred area to keep its flexible texture. It is important to moisture and massage the scarred areas at least twice a day for about 10minutes each time for the first two weeks.
After two weeks the skin is less fragile and you need to continue to moisture and massage the scarred area at least twice a day and apply more pressure to the scarred area.
To reduce the likelihood of the scar becoming problematic you can apply a silicone based gel or spray twice a day after massage. The silicone gel and spray will help to keep the scar hydrated, provide a barrier and normalise the growth factors, which means that it will help to reduce the collagen production in the skin and allow the scar to flatten, soften and reduce any redness. Silicone has been clinically proven to improve the look of the matured scar.
Should you become concerned about your scar you need to contact your GP in the first instance. Your GP may refer you to a specialist where your scar will be assessed on an individual basis and a treatment plan agreed.