Definition of scars
It is the permanent alteration of the cutaneous appearance following damage and its collagen repair. A difference is established between clinical situations depending on the size, color, extent, height, excessive growth along the edges of pathological development of the scar.
In normal wound healing, hemostatic processes begin, being independent of the depth of the lesion, being necessary to avoid excessive blood loss. These processes are inflammation, proliferation and remodeling.
Types of scars:
• Mature scar
• Immature scar
• Hypertrophic scars
• Other types : atrophic, retractable, unstable, enlarged and self-inflicted scars.
If you have keloids, you have two solutions to get rid of them. Either you can reduce them by surgery, or you can opt for a natural treatment. Conventional treatments like surgery have several drawbacks. They are ineffective, expensive, and keloid scars tend to recur even after surgery. Our natural treatment to remove keloids is composed of 2 elements: an balm and a herbal tea. The anti keloid balm is a mild natural remedy, but very effective in eliminating keloids. It contains plants that regenerate the skin, which is excellent for the natural treatment of keloids. As for the herbal tea, it strengthens the action of the ointment. It is a natural solution to eliminate keloids without surgery.
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In order to assess a scar, clinical monitoring of the patient is important for the comparative evaluation of different treatments. In 1978, the first systemic technique was created to evaluate scars by evaluating them on the basis of 3 variables :
• Color (white-pink / purple-red)
• Thickness (flat-slightly raised-prominent)
• Coherence (white-medium hard-hard)
Hypertrophy is characterized by an excessive proliferation of the scar and which does not extend beyond the edges of the initial wound.
The growth of the hypertrophic scar begins after the wound has closed and develops over the next 6 to 8 months, after which progression is stopped.
This process can take up to 2 years. The causes of this type of scar are not clear, but the mechanical factors are those which contribute most to its establishment, as well as the anatomical location, young age, origin of the wound and infections.
Infected wounds are the ones that develop the most hypertrophic scars. Inflammation over an extended period induces long-term production of collagen from fibroblasts which are less likely to undergo the normal process of apoptosis.
This hypertrophic scar can be linear, as it often happens in the areas of the neck and shoulders, it is a red, raised, sometimes irritating scar. There are also prolonged hypertrophic scars that are often the result of a burn and are seen after a prolonged healing period.
Keloids are characterized by a pseudo-tumor proliferation which extends beyond the edges of the initial wound. A keloid may continue to grow over time, showing no signs of stabilization. It begins to develop after the wound has closed or after one year. Risk factors may be genetic components, the Caucasian race has less prevalence of keloids than the Asian race, the Black race has the highest prevalence and young women are most at risk.
The anatomical areas where keloids most often occur are the ear lobes, neck, shoulders and sternum.
Keloids tend to reappear after surgery.
There are many hypertrophic and keloid scars that appear and the criterion for differentiating them is that the hypertrophic scar is limited to the original edges of the wound, while the keloid extends beyond the edges of the original lesion .
Keloids can be:
• Minor keloid, itching and high focused scar that spreads over normal tissue (acne scar).
• Major, large, raised, painful or itchy keloids that extend beyond normal tissue, these develop over large areas causing hanging tumors.
A scar should be flat and narrow, a little paler than the surrounding skin and this does not change the appearance of the patient. It all depends on certain factors. Certain measures applied immediately after the wound is closed will prevent the formation of an abnormal scar, it mainly depends on 2 factors:
1. The degree of risk to the patient of developing excessive scar tissue.
2. The patient's level of aesthetic concern and the motivation to take preventive measures.
Risk factors for the formation of excess scar tissue and unsightly tissue are linked to:
• The depth of the lesion. If it is surgical, it will be conditioned to the fact that it was performed in a fold or parallel to the Langer lines. If it is an irregular wound, with crushing, cleaning, etc.
• Acute treatment, correct debridement, infection prevention, surgical treatment or not, tension-free closure, etc.
• Location of the wound, there are more sensitive areas such as the pre-sternal and the deltoid tend to develop hypertrophic scars, and the scars on the back and shoulders are generally extensive and atrophic
• Age is another factor, because in childhood there is a tendency to hypertrophy.
• The skin type is another factor. Darker skin is more sensitive to hypertrophic and keloid scars, and even more so in redheads.
If a patient has one or more risk factors, it is advisable to provide information on preventive measures. This number of preventive actions also depends on the degree of aesthetic concern of the patient.
The general preventive measures are:
• UV protection: exposure to sunlight will increase the amount of dark melanin pigment. The purpose of melanin is to absorb UV radiation and dissipate energy in the form of heat to reduce the negative effect of UV rays. Therefore, it is recommended to avoid exposure to the sun and the use of sunscreens for the usual care of a surgical wound. The sun protection factor and its application influence the amount of UV radiation blockage. A thickness of 2 mg / cm on the skin offers a high level of photoprotection. The best protection is obtained with the application of sunscreens 30 minutes before exposure and the recommendation to completely block the sunlight is SPF 50+: It is also important to wear clothes and a hat with wide brim and to put shade.
• Moisturizers and bandages that retain moisture. Especially in pruritic scars, moisturizers have a beneficial effect.
• Moisturizers are agents that preserve or increase the humidity of the skin, there are substances that have an emollient or hydrating action. Lactic acid and urea are natural components that hydrate, soften and revitalize the skin. Hydrate it scar after recapitalization is completed, to prevent the formation of abnormal scar tissue. Among the emollients are mineral oils, petroleum jelly, fatty acids, wax esters, silicone oils, etc.
• Massage is necessary to apply it, carefully adapting this technique to the stage of inflammation. In case of high inflammation, only hydration is used.
• When the inflammation has been reduced, skin mobilization can improve skin sliding plans and reduce adhesions. To stretch the skin next to a scar, two fingers are placed at the start of the scar, and the skin above the scar is stretched in a parallel direction. Infection is a contraindication to massage, moreover, it is not indicated in keloids, with the exception of the hydration part.
• Too intense a massage can increase inflammation.
• Reduction of tension and occlusion. Tension plays an important role in crosslinking, once the suture is removed, the scar is sensitive to the forces of skin tension; If the forces across the scar are able to overcome the resistance of the initial collagenic bonds, a prolongation of the inflammatory phase occurs, which gives an additional increase in fibroblast activity. The use of sterile adhesive tapes or sutures ("steristrips") can reduce tension when the stitches are removed and, therefore, is indicated during the healing period of the lesion to prevent hypertrophy caused by stimuli tension and traction
In a normal thickness wound, the loss of transepidermal water increases considerably, especially in cases of hypertrophic and keloid scar and the consequence can be a prolonged production of collagen by fibroblasts. It has been shown that a moist environment is necessary to reduce fibroblasts, collagen and the production of matrix elements.
The use of a microporous product such as tape or "steritrips" restores the scar.
The application of fluid silicone gel represents an alternative for the effective induction of the softening of the scars, the reduction of redness and the improvement of itchy symptoms.
The beneficial effects of the silicone gel are a decrease in the evaporation of water, therefore a greater hydration of the stratum corneum. The application of the silicone gel and in combination with an occlusive bandage, forms a silicone film. It similarly hydrates and occludes tissue and is also effective in reducing the formation of hypertrophic scar tissue.
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