Treating scars: how to best care for a wound

Scars are a part of life. There are no official figures from Switzerland on how many people have a scar. But according to an older survey for a pharmaceutical company (in German), one in four women and one in ten men in Germany has a scarred area on their skin.

As a child, you get scars all the time – you run too fast, trip, fall and scrape and bloody your knee. However, such superficial scratches don’t usually cause permanent skin damage. But, says Firat Aslanel, surgical dermatologist at the Hautwerk practice in Zurich: «Scars develop in the connective tissue when the deeper dermal layers of the skin are damaged – through accidents, operations, inflammation or conditions such as acne. A scar is the result of the biological healing process of a wound.»

Before the scar is after the injury: how wounds heal poorly

If your skin is more deeply injured, new collagen fibre tissue develops. But unlike healthy tissue, where the collagen fibres appear neat, the new tissue looks irregular after a wound, forming a scar. If you’re interested in the details of what happens pathophysiologically, read the article by scar specialist Aslanel (in German) for the specialist magazine «Leading Opinions – Dermatologie und Plastische Chirurgie». In it, he described in detail the «chain of responses at local and systemic levels that follow a specific timetable.»

For laypeople, it can be summarised briefly as follows: as vasculogenic mediators are also involved in collagen formation during wound healing, they can cause disruptions to the wound healing process, creating scars.

«Scars can change their texture, feel hard, itch, or develop a pigment disorder, turning dark red,» says Aslanel, describing possible wound healing disorders. «In addition, the surrounding tissue may look different to the scar itself and vessels may form on the scar.»

The medical community differentiates between four types of scars:

• Mature scars, which to a certain extent represent the desired, i.e. non-pathological form. These scars are pale and soft, and not pigmented, itchy or painful. Nevertheless, they can be stressful for those affected. An example of this is self-harm scars on the forearms, which can have a stigma attached to them.
• Pathological scars include hypertrophic scars. This very common type of scar develops as raised and is usually red. They can also be itchy and tight.
• «In contrast, the reactions of keloid scars extend beyond the scar area,» says the doctor. They’re often confused with hypertrophic scars, but the small, hemispherical, reddened skin lesions grow in the surrounding tissue rather than on the original wound.
• Hypotrophic scars appear as dents in the skin and are usually caused by inflammation such as acne or chickenpox.

What causes pathological scars?

Basically, science doesn’t yet know exactly why some people tend to develop more severe scarring than others. What’s interesting is that scarring not only varies from person to person; the same person’s healing can go smoothly one time and not the next. Aslanel reports on one of his patients: «I operated on him three times and nothing happened. The fourth time using the same incision technique and the same suture material, the scar became significantly worse. I suspect multifactorial genesis – there must be several pathological causes.»

Doctors can’t prophetically predict whether pathological scars will develop after an operation, for example. «Any surgical intervention can form a scar. But we simply never know how scars will heal.»

Nevertheless, there are medical requirements that can reduce the likelihood of scarring. «The most important thing is that the surgeon makes a good incision. But that usually happens anyway.» However, if incisions are made in the wrong direction and skin tension lines are ignored, scarring is very likely. The same applies to mechanical loads, i.e. tension and movement. Dirt, chemotherapy and aggressive medication (to treat severe acne, for example) can also have a negative impact on wound healing.

How scars heal well: what you can do

Does every wound need scar care? «Theoretically not, but practically yes,» says the dermatologist. «A scar can look good today, but it might not in four or six weeks. So, keep the wound clean and protect it from infection and also from the sun with a disinfectant cream and bandage. You shouldn’t get into a swimming pool with a fresh surgical wound.»

Once the wound has healed, special scar gels or creams can be used – after consulting a doctor – to make the tissue more supple. «But you still never know whether the scar will get better or not.»

The dermatologist doesn’t rate mechanical products such as scar rollers: «How can a mass-produced product be equally good for everyone? And also for anywhere on the skin? Scar care must always be specifically selected and adapted to individual needs.»

So, that means: ask your doctor which cream he or she recommends.

How do you treat stubborn scars?

If, despite everything, a pathological, stubborn scar has developed, dermatology can tackle it – when it comes to colour, texture and also pain. For hypertrophic scars, for example, silicone plasters can be applied or cortisone injected to make the scar tissue flatter.

In addition, special laser medicine devices are used at specialist dermatology clinics such as Hautwerk.

If a hypotrophic, i.e. dented (acne) scar has developed, the experts have to work deeper to build up tissue – with thermomechanical or radiofrequency devices and microneedling plus a special blood plasma treatment. If you want to know more about the medicine, dermatosurgeon Aslanel describes the various treatment methods for specialists in the report linked above.

By the way: not every stubborn scar needs to be lasered. Doctors decide whether special lasers, radio frequency, microneedling or injecting filling material are suitable for scar treatment on a case-by-case basis. In addition, technology shouldn’t be used too aggressively, as it could potentially make the scar worse instead of improving it.

Ideally, however, the result, whether used for medical, aesthetic or cosmetic reasons, is almost invisible, says Firat Aslanel: «Scars can never be completely hidden, but modern treatment methods can make many of them hardly noticeable.»