Scars - Treating scars

People seek help for scars if they are painful or itchy, if they are unsightly, or if they restrict movement.

Although scars cannot be removed completely, they can often be made less visible. However, more research is required to assess the effectiveness of the different treatments.

Your GP may refer you to a dermatologist or a plastic surgeon for treatment.

Some treatments – such as laser therapy – are not widely available on the NHS, so you will need to pay for them privately.

Corticosteroid injections

Corticosteroid injections are used to treat some keloid and hypertrophic scars.

Multiple small injections are made into the scar to reduce any swelling (inflammation) and to flatten the scar. Depending on the type of scar, these may need to be repeated. Injections are usually given on three occasions, at four- to six-week intervals, to assess your body’s response. Treatment may sometimes continue for several months if the scar is improving.

This treatment cannot remove scars, but it can improve their appearance.

Silicone gels or sheets

Silicone gels or sheets are available from some pharmacies. They are used on healing skin (not open wounds) to reduce redness and to try to minimise hypertrophic or keloid scars.

To be effective, silicone gels or sheets should be placed over the scar for 12 hours a day, for at least three months.

You can ask your GP, dermatologist or pharmacist for more advice about a range of silicone-based scar treatments.

Surgery for scars

Surgery can sometimes improve the appearance of scars, as it can be used to:

• change the positioning of the scar
• change the width or shape of the scar
• release a tight scar that is close to a joint, to improve movement

Be aware that having surgery on your scar will leave a new scar that will take up to two years to improve in appearance. If surgery is used to treat a hypertrophic scar, there is a risk that the scarring may be worse after the surgery.

Surgery alone is not advised for keloids, as they tend to grow back larger. Surgery for keloids is often combined with corticosteroid injections at the site of the removed scar immediately after surgery. Some plastic surgeons also add other treatments, such as X-ray therapy and oral antibiotics, to try to minimise the recurrence of a keloid that has been surgically treated. You can talk to your surgeon about this treatment.

Pressure dressings for scars

The aim of pressure dressings is to flatten and soften scars. They are most often used for large burn scars or after skin grafts.

Pressure dressings are usually made from a stretchy, elastic material. They are worn over the scar 24 hours a day, for around 6 to 12 months. They can also be used in combination with silicone gel sheeting, to improve the appearance of scars over a long period of time.

Pressure dressings are usually used under specialist supervision.

Make-up for scars

Cosmetic camouflage (make-up) can help cover up scars and can be particularly useful for facial scars. Some are waterproof and can stay in place for two or three days.

Camouflage make-up that is specially designed for covering up scars is available over the counter at pharmacies. You can also ask your GP for advice.

Please note that camouflage colour testing (to get a good colour match for your skin type) can be a lengthy process, sometimes taking over an hour, and needs to be performed by someone who is qualified.

Laser therapy

Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue. For some pitted scars, laser surgery (laser re-surfacing) is used to try to make the scar flatter. This involves using a laser to remove the top layers of skin, which stimulates collagen production in the deeper layers.

However, there are very few long-term studies to prove the effectiveness and safety of this therapy. If you have laser therapy, it's important to make sure that the person carrying it out is a fully trained medical practitioner with experience in improving scars.

Dermal fillers

Dermal fillers are injections (often of a man-made acid) used to "plump up" pitted scars. Treatments can be costly and the results are usually temporary. Repeat treatments are needed to maintain the effect.

Skin needling

Skin needling, which involves rolling a small device covered in hundreds of tiny needles across the skin, is also reported to be helpful, but repeat treatments are often needed to achieve an effect, and results vary considerably.

Radiotherapy

Low-dose, superficial radiotherapy may reduce the recurrence rate of hypertrophic and keloid scars after surgery. It is effective in about 70% of cases but, because of the possibility of long-term side effects, it is only reserved for the most serious cases.