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Elastic bandages are one of the most widely used treatments for scar tissue worldwide and have a proven effect in up to 60% of patients. The use of continuous pressure promotes scar maturation, although the mechanism is still unclear. Of greatest importance is probably the local limitation of oxygen access to the scar (hypoxia) and pressure changes leading to a reorientation of the ingrown collagen fibres.
Elastic bandages should be used for up to 23 hours a day. However, there are also numerous negatives, such as discomfort during wear, overheating of the body surface, the need to change, adjust and wash the dressings, the decrease in elasticity over time, the risk of mechanical damage to the wound or the difficulty of putting them on in children.
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Topical use of silicones (in the form of creams or sheets) has also been shown to have an effect on scar maturation. Again, the effect is probably due to a reduction in scar dehydration by replacing the immature stratum corneum. The use of silicones should only be initiated after the wound has healed completely and sufficiently.
The duration of treatment includes the period of changes in the scar tissue. Silicones should be used slowly and with a gradually increasing intensity. However, silicone treatment has a number of complications – the most common are skin irritation, silicone intolerance, itching, maceration and difficulty combining with elastic devices.
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Laser is one of the modern methods of scar treatment with a proven positive effect on a wide range of scar parameters. The development of new methods of laser use has led to a broadening of the spectrum of its use for both mature and fresh scars. The most commonly used in scar therapy are the so-called pulsed dye laser (PDL) and fractional ablative laser. Both methods can be combined. However, laser therapy must be performed in a facility with knowledgeable staff and experience in scar treatment.
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Local injection of steroids into the scar reduces the height and volume of the scar, reduces pain, itching and increases the elasticity of the scar. Corticosteroid injection is the method of choice for keloid scars. A keloid scar, unlike a hypertrophic scar, extends beyond the extent of the original injury. In hypertrophic scars, steroid application is usually part of a multimodal treatment strategy.
ITCHING
Itching is an uncomfortable and bothersome sensation that leads to compulsive scratching and accompanies the scar maturation process, most commonly in burns. It is related to the release of local factors that irritate peripheral nerves. It peaks around the sixth month after healing and its origin is multifactorial. Itching can limit quality of life, especially in children.
Treatment is based on routine measures, topical and general preparations. The available methods often need to be combined.
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- Dietary modification (no irritating foods)
- cotton underwear
- more frequent ventilation of the room
- minimise overheating and sweating
- limit bathing, prefer showering with lukewarm water (no more than 35 °C), use non-irritating soaps and cotton towels
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- is based on intensive moisturizing (dry skin is more itchy), products with aloe vera are preferred
- in acute cases cooling will help
- massage also helps by reflex mechanism
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- Antihistamines and other medications (psychopharmaceuticals) prescribed by a specialist
Manifestations of neuropathic scar pain are common and are related to chaotic nerve ingrowth into the scar. Treatment is usually pharmacological and should be carried out by a specialist. Common analgesics (e.g. ibuprofen) usually have little effect on reducing pain.
