Prevent Keloid and Hypertrophic Scars

Nothing can leave you feeling more self-conscious than a nasty scar. While some scars are simply unavoidable after an abrasion, burn, or cut, there are proven techniques that can help you reduce the appearance of a scar. Two of the most common forms of scar tissue are keloid and hypertrophic. They normally form over a cut or wound to the skin. In general, keloid scars are more difficult to identify and treat than hypertrophic scars, but both can prevented, especially with the advice of a trained doctor.

Steps

Understanding Risk Factors

1. Identify the risk factors for keloid scar formation. Keloid scars are more commonly found on the arms, upper chest, and upper back. They grow beyond the borders of the original abrasion and appear as red, raised nodules. Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. You can also develop a keloid scar from a cut, a piercing, or acne.
   • Keloid scars are more difficult to prevent and treat, but early recognition can lead to either prevention or at least reduction.
   • People with darker complexions, pregnant women, teens, individuals under 30, and others with a history of keloid scarring may be more susceptible to keloid scar formation.
2. Know who is at risk for hypertrophic scar formation. Hypertrophic scars are less visible and stay within the boundaries of the original damage. They become flatter and paler over time. While men and women are equally susceptible to hypertrophic scarring, there are specific groups that are more prone to it. People at higher risk include those who:
   • use surgical blades (because they are at a higher risk of cutting themselves)
   • are overweight
   • have Native American or Alaskan Native heritage
3. Talk to your doctor. Before deciding on what method to use, consult your physician. Everyone's skin is different and every scar causing injury is different too. Your doctor will be able to tell you whether simple silicone coverings will work or if more extreme measures are necessary to reduce the size of scars or to get rid of them all together.
4. Avoid non-essential cosmetic surgeries. If you have a history of keloidal scarring, then you may want to avoid any non-essential surgeries to prevent scarring. All surgical wounds should be closed with the least amount of tension around the incision. Incisions should not cross joint spaces, which are prone to excessive stretching. Mid-chest incisions should be avoided for the same reason.
   • If you have to get surgery and a scar is unavoidable, there are laser techniques surgeons can use to reduce the appearance of scars.

Reducing the Appearance of Scars

1. Apply a protective silicone sheet over the affected area. Silicone sheeting is a medical device used to reduce the formation of chronic scarring. It can alter the way scars form and even reduce the thickness and roughness of the tissue.
   • Silicone sheets keep healing wounds moist, while reducing bacterial growth. They also reduce general itching.
2. Use silicone sheets as prescribed by your doctor. Normally, your doctor will tell you to apply the silicone sheeting after the wound has fully closed. If you apply them earlier, you could promote the growth of anaerobic bacteria under the skin, which will lead to greater infections. The sheet is worn on the area for 12 to 23 hours a day depending on the severity and placement of the scar. This treatment may be prescribed for up to three months.
3. Consider silicone dioxide. This mixture can be applied to the injured area in either a gel or a pad form. This compound is also found in silicone sheets. It will help soften the scar tissue and decrease the redness associated with the formation of a keloid scar.
4. Consider cotton wool pressure dressings. In burn cases, pressure garments are often used to treat specific areas. These pressure garments are worn 23 hours a day for up to one year. These dressings do not cut off air to the tissue and can be customized to the specific injury. Pressure dressings are anecdotally effective in management of hypertrophic scars and burn scars.
   • However, there is no evidence to support the use of pressure dressings to improve the appearance of normal post-surgical scars.

Considering Other Treatments

1. Ask your doctor about steroid injections. Steroids are injected straight into the scar tissue to help decrease itching, redness, and general discomfort. Some doctors note that the treatment of these symptoms with steroidal injections can also reduce the appearance of scars.
   • Steroid injections (triamcinolone) are given every two to six weeks until improvement is seen. Occasionally, injections can cause a network of surface veins to develop (telangiectasias), or lightening or thinning of the surrounding skin.
2. Try cryotherapy. Research has shown that cryotherapy can decrease the thickness of the scar tissue by up to 58%. The earlier the treatment and thinner the keloid scar, the better the results. Cryotherapy is performed in the physician office using medical instruments that instantly freeze the tissue and kill it on contact.
   • Cryotherapy can cause burns, more scar formation and damage to nearby healthy tissue if done improperly. When cryotherapy is used to treat keloid tissue, further preventative methods must be used as the area heals, such as silicone dioxide, silicone gel sheets and steroid injections.
3. Ask about radiation therapy. Another option for reducing the appearance of keloid scars is radiation therapy. Some plastic surgeons avoid this method of scar removal due to concerns about causing tumors, but studies have shown that this is a safe method as long as surrounding tissues are protected.
4. Discuss surgical excision with your doctor. By itself, surgery can often cause further aggravation and create more scars, but if performed in combination with a number of other treatments (e.g. silicone sheeting and silicone dioxide), surgery can reduce the visibility of such scarring. Once the surgical excision has healed, discuss the use of silicone gel sheets to reduce the recurrence of the scar formation.
   • If you decide to go the surgical route, ask your doctor about Imiquimod. It is a cream that enhances healing and is often used after surgery to prevent scarring. The cream is applied on alternate nights for eight weeks after surgery. Although the trials have been small, the post-surgical recurrence rate averaged only 28 percent over a six- to nine-month follow-up period, with best results (2.9 percent recurrence) in low skin tension areas such as earlobes.

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Sources and Citations

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