Scar Biology

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The scar tissue does not have a fully developed stratum corneum – its own barrier, which has a great influence on the hydration of deeper parts of the skin. This allows inadequate water loss through the skin. The scar therefore becomes dehydrated, and the sebaceous glands are also destroyed after the injury. Thus, the scar tends to be dry.

Dryness of the scar increases the activity of the cells in the scar, which then produce even more collagen fibres and worsen the character of the scar. A dry scar can be recognised by scaling. The ideal scar lubricant should meet several criteria: it should penetrate as deeply into the scar as possible, it should not be allergenic or irritating and it should be affordable.

UV protection and compatibility with possible pressure devices are highly desirable. There is therefore no single opinion or specific product to recommend. Some substances have an effect on the scar and it is advantageous if the product contains them, e.g. aloe vera extracts have shown a positive effect on hydration and itching. Vitamin E is also recommended. The creams may also include other plant extracts that affect inflammation in the scar.

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.

  • Routine measures

    • 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

  • Topical treatment

    • 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

  • Systemic treatment

    • 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.