Prevention of “Scars”

Scars are a natural result of the body’s wound healing process, occurring when the skin and underlying tissues are injured. Although scarring is part of the natural healing process, in some cases, scars can cause both health and psychological problems, especially when they are large, overly raised, or in visible locations.

Preventing abnormal scarring is therefore important for overall skin health and quality of life. This article will present the principles of scar formation, the biological mechanisms involved, and evidence-based prevention methods, enabling readers to understand and effectively apply this knowledge to self-care or patient care.

Principles and Causes of Scar Formation

Scar formation is part of the body’s natural wound healing process, which consists of four important stages:

1. Hemostasis: Occurs immediately after injury. The body responds by constricting blood vessels and activating platelets. Platelets aggregate to form a temporary blood clot, which helps stop blood flow and prevent excessive blood loss. The blood clot also serves as a temporary structure for various cells that will enter in the next stage.
2. Inflammation: This stage begins almost immediately after injury and can last up to 6 days. Immune cells such as neutrophils and macrophages are attracted to the wound area through chemical signals released by injured cells and bacteria. These cells function to eliminate pathogens, dead tissue, and other foreign substances. They also release substances that stimulate the formation of new cells and blood vessels.
3. Proliferation: This stage begins about 2-10 days after injury and can last up to two weeks. Fibroblast cells are stimulated to move into the wound area and begin producing collagen and new tissue called “granulation tissue” to fill the wound. At the same time, keratinocyte cells move from the wound edges to create a new outer layer of skin (re-epithelialization). New blood vessels are also formed (angiogenesis) to supply oxygen and nutrients to these new cells.
4. Remodeling: This is the final and longest stage of wound healing. It begins about 21 days after injury and can last up to a year or more. During this phase, type III collagen, which was produced in the early stages, is replaced by stronger type I collagen. Collagen fibers are rearranged to increase strength. However, even after remodeling, the repaired tissue will only have 70-80% of the strength of normal skin.

According to studies by Gauglitz et al. (2011) and Zhu et al. (2020), factors affecting abnormal scar formation include:

• Genetics: Some people have a genetic predisposition to develop hypertrophic scars or keloids more than others.
• Age: Older people tend to have slower collagen production, which may result in slower wound healing and increased chances of scarring.
• Wound location: Wounds in areas with high movement, such as joints, or areas with high tension, are more likely to develop prominent scars.
• Severity of injury: Deep and wide wounds are more likely to result in visible scars.
• Wound healing time: Wounds that take longer to heal have a higher risk of developing abnormal scars.
• Excessive infection or inflammation: Severe infection or inflammation can disrupt the normal wound healing process and lead to abnormal scarring.
• Skin tension: Areas with high skin tension, such as the chest, shoulders, or upper back, are more prone to hypertrophic scars or keloids.
• Ethnicity: Some ethnicities, such as people with dark skin and Asians, are more prone to hypertrophic scars and keloids than Caucasians.

Understanding these processes and related factors is crucial in developing effective scar prevention methods.

Methods for Preventing Scars

1. Proper Wound Care Proper wound care is the first and most important step in preventing scars. A study by Monstrey et al. (2014) found that maintaining wound moisture and preventing infection are crucial in reducing the chances of abnormal scarring. Recommended wound care methods include:

• Wound cleaning: Use clean water or saline solution to gently wash the wound to remove dirt and bacteria.
• Maintaining moisture: Use moisturizing products such as petroleum jelly or creams containing petrolatum to prevent wound drying and promote faster wound healing.
• Wound covering: Use appropriate dressings to prevent contamination and maintain moisture.
• Avoiding wound disturbance: Try not to scratch scabs or rub the wound to reduce the chances of infection and scarring.

2. Using Silicone Gel and Sheets Several studies support the effectiveness of silicone products in preventing and treating scars. Bleasdale et al. (2015) found that using silicone sheets or gels can significantly reduce the risk of hypertrophic scars and keloids. The mechanisms of silicone in preventing scars are as follows:

• Moisture retention: Silicone helps retain moisture in the skin, creating an environment suitable for wound healing.
• Reducing excessive collagen production: Silicone may help control collagen production, preventing excessive scar tissue formation.
• Protection from irritation: Silicone sheets help protect the wound from impacts or friction from the outside.

It is recommended to use silicone products after the wound has closed completely, using them continuously for at least 12 weeks or as advised by a doctor.

3. Scar Massage Scar massage is an accepted method for preventing and treating scars. Shin and Bordeaux (2012) reported that regular scar massage can help reduce tissue adhesion and improve the appearance of scars. Benefits of scar massage include:

• Increased flexibility: Massage helps make scar tissue more flexible, reducing tension and adhesion.
• Stimulating blood circulation: Massage helps increase blood flow in the scar area, promoting tissue regeneration.
• Enhancing product absorption: Massage can help creams or gels used in scar treatment to be better absorbed.

It is recommended to start scar massage about 2 weeks after the wound has closed completely, gently massaging 2-3 times a day for 5-10 minutes each time.

4. Using Sunscreen Protecting the wound from UV radiation is important in preventing the development of darker scars (hyperpigmentation). Foo and Sarma (2016) recommend using sunscreen with at least SPF 30 on the scar area to prevent skin color changes. Reasons for protecting scars from sunlight include:

• Preventing pigmentation: UV rays can stimulate the production of melanin pigment in the skin, causing the scar to darken.
• Reducing inflammation: Sunlight can cause inflammation in the scar area, which may worsen the appearance of the scar.
• Protecting collagen: UV rays can destroy collagen in the skin, causing the scar to have an uneven appearance.

It is recommended to use sunscreen every day, even on cloudy days, and reapply every 2-3 hours if outdoors.

5. Laser Treatment For wounds with a high risk of abnormal scarring, early laser treatment may help prevent it. Ke et al. (2020) found that using pulsed dye laser (PDL) in the early stages of wound healing can reduce the chances of hypertrophic scarring. Benefits of laser treatment include:

• Reducing inflammation: Some types of lasers can reduce inflammation in the early stages of wound healing.
• Stimulating collagen production: Lasers can stimulate the production of new collagen, helping improve the appearance of scars.
• Adjusting skin color: Some types of lasers can help reduce redness or darkness of scars.

However, laser treatment should only be done under the care of a specialist doctor and may require multiple sessions for the best results.

6. Using Topical Steroid Medications In cases where there is a tendency to develop hypertrophic scars or keloids, doctors may consider using topical steroid medications to reduce inflammation and inhibit excessive collagen production. Robles and Berg (2007) found that using moderate to high-strength topical steroids can help prevent and treat hypertrophic scars. The mechanisms of action are as follows:

• Reducing inflammation: Steroids have anti-inflammatory effects, helping reduce swelling and redness of the wound.
• Inhibiting collagen production: Steroids can reduce the activity of fibroblast cells, which produce collagen.
• Reducing new blood vessel formation: Steroids can inhibit the formation of new blood vessels in the wound area, which may help reduce hypertrophic scarring.

The use of topical steroid medications should only be under the care of a doctor, as long-term use may have side effects such as skin thinning or abnormal skin pigmentation.

Summary

Scar prevention is a process that requires the use of multiple methods together, starting from understanding the mechanisms of scar formation to using appropriate prevention methods. The key approaches to preventing scars can be summarized as follows:

1. Proper wound care from the early stages, focusing on maintaining cleanliness and moisture of the wound.
2. Using silicone products when the wound begins to close to prevent abnormal scarring.
3. Regular scar massage to increase flexibility and reduce tissue adhesion.
4. Protecting scars from sunlight by using high SPF sunscreen.
5. Considering laser treatment or topical steroid medications under the care of a doctor in high-risk cases.

However, choosing the appropriate method depends on many factors such as the characteristics of the wound, location, and personal factors. Therefore, consulting a specialist doctor is important in planning effective scar prevention. Additionally, follow-up and adjusting treatment methods as appropriate is important, as individual responses to treatment may vary.

Future Trends in Scar Prevention

While the scar prevention methods mentioned above have been proven effective, research and development in this field continue to progress, which may lead to new, more effective methods in the future, such as:

1. Stem Cell Therapy: Pikula et al. (2019) studied the use of adipose-derived stem cells in scar treatment and found a tendency to improve scar appearance and increase skin flexibility.
2. Nanotechnology: Shirazian et al. (2020) reviewed the use of nanotechnology in scar treatment and found that nanoparticles can help deliver drugs and important substances into the skin more effectively.
3. Smart Wound Dressings: Mostafalu et al. (2018) developed smart wound dressings that can measure wound environment conditions and release drugs or important substances as needed.
4. Gene Therapy: Yeh et al. (2017) studied the use of gene therapy to control the expression of genes related to scar formation.
5. Artificial Intelligence (AI) and Machine Learning: Borsting et al. (2020) used AI and Machine Learning to analyze scar characteristics and predict treatment outcomes.

Conclusion

Effective scar prevention not only helps improve the physical appearance of the skin but also positively affects the quality of life and mental health of patients. Therefore, prioritizing scar prevention from the early stages is important in comprehensive skin health care. Future research and development of new technologies may lead to more effective and personalized scar prevention and treatment methods. However, the clinical application of these technologies requires careful research to confirm their efficacy and safety.

 

Reference

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3. Shin, T. M., & Bordeaux, J. S. (2012). The role of massage in scar management: a literature review. Dermatologic Surgery, 38(3), 414-423.

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14. Shirazian, S., Azghani, M., Ahmadi, H., & Mohammadi, Y. (2020). Potential applications of nanotechnology in the management of scars and skin ulcers: A comprehensive review. Journal of Drug Delivery Science and Technology, 56, 101506.

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