Our skin is a seamless organ, like a fine piece of cloth cloaking valuable assets. Any burn, injury, surgery or other trauma to it can cause the formation of scar tissue that can be downright ugly.

Imagine if you had a fine piece of silk: Even one small tear can make a difference in how it looks. But we're human: Throughout our lives, we will have experiences that nip and tear at our skin, either self-inflicted, or completely out of our control.

A scar isn't so bad if it's small or in a location that's easy to conceal. But often you want a way to treat those scars other than hiding them under clothing.

The truth is this: The scar will never completely go away, but there are some methods that can help reduce its size and appearance.

How does scarring happen?

Scar formation is a natural part of the healing process after injury.

Various factors influence how your skin scars. Of course, the depth and size of the wound or incision and the location of the injury are going to impact the scar's characteristics. But your age, heredity, even your sex or ethnicity, will all affect how your skin reacts.

What are the types of scars?

These are several different types of scars including:

• Keloid scars. These scars are the result of an overly aggressive healing process. These scars extend beyond the original injury. Over time, a keloid scar may affect mobility. Possible treatments include surgical removal, or injections with steroids. Smaller keloids can be treated using cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloid formation by using pressure treatment or gel pads with silicone when you sustain an injury. Keloid scars most often occur in Blacks.



• Contracture scars. If your skin has been burned, you may have a contracture scar, which causes tightening of skin that can impair your ability to move; additionally, this type of scar may go deeper to affect muscles and nerves.



• Hypertrophic scars. Raised and red scars that are similar to keloids, but do not breach the boundaries of the injury site. Possible treatments can include injections of steroids to reduce inflammation.



• Acne scars. If you've had severe acne, you probably have the scars to prove it. There are many types of acne scars, ranging from deep pits to scars that are angular or wavelike in appearance. Possible treatments will depend on the types of acne scars you have.

What are the possible treatments?

The treatments for scars will vary depending on multiple factors. Scar treatments may include:

• Over-the-counter or prescription creams, ointments or gels. These products can be used to treat scars that are caused from surgical incisions or other injuries or wounds. If you are under the care of a plastic surgeon and your scarring is the result of cosmetic or plastic surgery, ask your surgeon for his or her recommendation if over-the-counter treatment is sufficient; otherwise, he or she will prescribe that which best suits your personal case. Oftentimes, treatments can include corticosteroids or certain antihistamine creams for scars that cause itching and are extremely sensitive.
  
  Likewise, if you are under the care of a dermatologist for severe acne and have scarring as a result of acne, you should ask your doctor for his or her recommendation if you haven't already received it. Your doctor can also recommend or use pressure treatings or silicone gel sheetings to help treat scars or as preventative care.

• Surgical removal or treatment. There are many options to treat deeper wounds and scars depending on your particular case: skin grafts, excision, dermabrasion or laser surgery. You can receive a skin graft, where the surgeon removes skin from another area of your body. This is often used in the case of burn victims. If you've got scarring that impairs function, surgery can help address those problems. Like other surgeries, you and your doctor will determine together if you will have local anesthesia with an oral sedative or general anesthesia that will put you to sleep. If you've recently undergone plastic, cosmetic or other surgery that has caused your scars, it is best that you wait at least one year before making a decision about scar treatment. Many scars fade and become less noticeable over time.



• Injections. In the case of protruding scars such as keloids or hypertrophic, your doctor may elect to use steroid injections. He or she may use this as a stand-alone treatment, or in conjunction with other treatments.
  
  Other types of injects, such as collagen injections or other "fillers," may be useful for some types of pitted scarring although these are not usually permanent solutions.

Does insurance coverage apply to scar treatments?

If your scar is physically impairing you in any way, you may be able to get coverage from your insurance carrier. You can ask your doctor to write a letter detailing your particular case, such as if you are a burn victim. He or she can also take photos to help prove your case. If you are undergoing scar treatment for cosmetic purposes, you will most likely have to pay for it all yourself. If your scars are caused from cosmetic surgery, make sure you understand all the implications of insurance coverage for any elective surgery that is not medically necessary.

Reviewed by the doctors at The Cleveland Clinic, Department of Plastic Surgery.

Edited by Cynthia Dennison Haines, MD, April 1, 2005.

Portions of this page © The Cleveland Clinic 2000-2003.

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