Scar Treatment: Insights from our Dermatology Experts
A scar is a mark that is left on the skin after an injury, area of inflamed skin, surgical procedure or wound has healed. Scarring occurs as part of the body’s healing process. It’s the body's way of replacing and repairing damaged tissue. Scarring is permanent, but most scars will fade over time. This can take years, but there are steps that can be taken to improve the healing.
There are many different types of scars, they tend to vary in appearance and texture depending on certain factors such as the type, the severity of the injury, an individual's skin type and also how well the wound heals.
Types of Scars
These scars are raised and can occur anywhere you injure your skin. They most commonly appear on earlobes, shoulders, cheeks and your chest. They form when the body produces excessive collagen during the healing process, resulting in an often itchy scar that extends beyond the boundaries of the original wound. Keloids can be treated but this often requires medical intervention.
Hypertrophic scars are raised and thickened similar to keloid scars. The key difference is in a hypertrophic scar the extra connective tissue stays within the boundaries of the initial wound area. In contrast, with keloids, the extra connective tissue extends beyond the boundaries of the initial wound area. Hypertrophic scars may improve over time particularly with massage.
These scars are characterised by a loss of tissue, resulting in a dipped or sunken appearance. Some examples of this are certain acne scars - including, atrophic macular scarring.
Contracture scars often occur after the skin is severely damaged, leading to the tightening and pulling together of the surrounding tissue. These scars can restrict movement and may occur after burns or traumatic injuries.
Acne scars can take various forms, including ice pick scars (small, deep pits), rolling scars (wave-like indentations), and boxcar scars (shallow, angular depressions). They are often the result of inflamed acne lesions.
These scars result from surgical incisions and can vary in appearance depending on factors such as the location of the incision, the surgeon's technique, and how well the wound heals. Surgical scars can become keloids.
Burn scars can range from mild to severe and may appear red, raised, or shiny. In severe cases, they can cause significant functional and cosmetic impairment.
Stretch marks are a type of scar that occurs when the skin is stretched rapidly, causing the collagen and elastin fibres to rupture. They often appear as streaks or lines on the skin and are commonly associated with pregnancy, rapid weight gain or loss, and puberty. They can also occur in certain medical conditions, like cushings disease.
Additionally, practising good wound care and protecting the skin from infection or further injury can help minimise the risk of excessive scarring.
The Benefits of Scar Massage
Massaging a scar can be helpful in scar management. Studies such as the systematic review by Santuzzi et al. (2023) demonstrate that scar massage, can reduce pain and scar itching while improving scar characteristics like thickness and melanin content.
Additionally, Morien et al. (2008) found in their pilot study that scar massage led to significant increases in range of motion, indicating its efficacy in promoting tissue flexibility and mobility in children with burns.
Initiating scar massage too soon after healing can potentially be damaging. Shin and Bordeaux (2012) warn in their literature review published in Dermatologic Surgery that premature massage may disrupt the delicate healing process, leading to increased scar formation or widening. Therefore, it's crucial to wait until the scar has fully matured before initiating massage therapy, as recommended by Morien et al. (2008) and Santuzzi et al. (2023).
Scar Massage devices
There are a number of publications that have shown some benefit with use of scar massage devices in improving motion, mobility, and strength of scars.
Scott et al. (2024) highlight the effectiveness of scar massage tools in improving soft tissue glide, reducing hypersensitivity, and increasing hand function in post surgical scars. Cho et al. (2014) also demonstrated in their study published in Burns that burn rehabilitation massage therapy using a device improved scar characteristics such as thickness, melanin (pigmentation), and erythema (redness), indicating its potential for scar rehabilitation.
Dr Glass, Consultant Dermatologist at The Dermatology Clinic London recommends his patients massage their scars daily for about 6 weeks, only after they are fully healed.
Mousiurisers, balms & creams for scar management.
Dr Glass suggests a balm or moisturiser such as petroleum jelly or silicone gel is used when massaging. Using a balm alongside scar massage can enhance efficacy and comfort. Shin and Bordeaux (2012) note in their review published in Dermatologic Surgery that while scar massage promotes tissue re-modeling and improves appearance, applying a balm provides lubrication and hydration, making massage more comfortable and effective. Combining massage with a suitable balm, as suggested by Scott et al. (2022) in their study published in the Journal of Hand Therapy, optimises scar management and enhances patient comfort during rehabilitation.
Certain creams containing specific ingredients have been proposed as being beneficial for scar management. Ingredients like silicone, vitamin E, and hyaluronic acid can be found in scar creams and some have shown efficacy in improving scar appearance and reducing pruritus (itching). Lin et al. (2023) found in their meta-analysis published in the Journal of Clinical Nursing that massage combined with silicone therapy significantly improved scar appearance and reduced pruritus.
Rathore et al. (2014) demonstrated in their study published in Ophthalmic Plast Reconstr Surg the efficacy of massage with silicone gel and steroid ointment in improving scar outcomes, supporting the use of creams containing these ingredients for scar management. However further research with randomised controlled trials is necessary in this field to establish for certain whether particular ingredients improve scarring.
If you have any questions or concerns about a scar that is of concern to you for whatever reason, reach out to our team of Dermatologists for help.
References
- Cho, Y. S., Jeon, J. H., Hong, A., Yang, H. T., Yim, H., Cho, Y. S., ... & Seo, C. H. (2014). The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial. Burns, 40(8), 1513-1520.
- Lin, T. R., Chou, F. H., Wang, H. H., & Wang, R. H. (2023). Effects of scar massage on burn scars: A systematic review and meta-analysis. Journal of Clinical Nursing, 32(13-14), 3144-3154.
- Morien, A., Garrison, D., & Smith, N. K. (2008). Range of motion improves after massage in children with burns: a pilot study. Bodyw Mov Ther, 12(1), 67-71.
- Rathore, D. S., Chickadasarahilli, S., Crossman, R., Mehta, P., & Ahluwalia, H. S. (2014). Full thickness skin grafts in periocular reconstructions: long-term outcomes. Ophthalmic Plast Reconstr Surg, 30(6), 517-520.
- Santuzzi, C. H., Liberato, F. M. G., Oliveira, N. F. F., Nascimento, A. S. D., & Nascimento, L. R. (2023). Massage, laser and shockwave therapy improve pain and scar pruritus after burns: a systematic review. Journal of Physiotherapy, 70(1), 8-15.
- Scott, H. C., Robinson, L. S., & Brown, T. (2022). Scar massage as an intervention for post-surgical scars: A practice survey of Australian hand therapists. Journal of Hand Therapy, 35(2), 186-199.
- Shin, T. M., & Bordeaux, J. S. (2012). The role of massage in scar management: a literature review. Dermatologic Surgery, 38(3), 414-423.