Week 3: Scar & Skin Lesions

  • scars → mark in the skin that is caused by a wound/ulcer → remains even after healing

  • what are the different types of scars? → flat & pale (most common) , hypertropic (abnormally large or excessive growth of scar tissue etc..) and keloid, acne, sunken, stretched

what makes the types of scars different from each other?

  • flat & pale → red/dark and raised after healing → pales and flattens over time (might blend in over time)

  • hypertropic & keloid → raised overgrowths of scar tissue at injury site → trauma/surgery/blisters/vaccinations/body piercing [causations] → imbalance in collagen during healing process, grows indefinitely & might not become paler/improve in appearance over time.

what is the difference between HS and K scars?

  • K enlarges beyond normal size & shape of the wound created → doesn’t improve over time

  • HS enlarges within the original size of the wound created → tends to improve over time

  • Acne Scars

→ different from macules which are flat, red spots that remain up to 6 months after flattening of inflamed acne lesions. Disappears over time.

→ post-inflammatory pigmentation, discoloration of skin at injury sites that is healing or healed, up to 18 months

Type of Scar

Description

Characteristics

Flat & Pale

Marks caused by wounds that remain even after healing.

Initially red or dark and raised, later they pale and flatten over time, potentially blending in.

Hypertropic & Keloid

Raised overgrowths of scar tissue at the injury site due to various causes (trauma, surgery, etc.).

Grows indefinitely and may not become paler or improve in appearance over time.

Acne Scars

Scars following bouts of acne, different from flat, red macules.

Can have post-inflammatory pigmentation that lasts up to 18 months.

Macules

Flat, red spots

Remains up to 6 months after inflamed acne lesions is flattened.

Disappears over time.

Rolling Acne Scars

Broad depressions with sloping edges.

sloping edges

Boxcar Acne Scars

Broad depressions with sharp edges.

sharp edges

Ice-Pick Acne Scars

Deep, narrow, pitted scars.


what are the different types of acne scars?

  • rolling → broad depressions, sloping edge

  • boxcar → broad depressions, sharp edges

  • Ice-pick → deep and narrow, pitted

  • Sunken Scars → recessed into the skin → chicken pox/ Ice-pick scarring acne.

  • Stretched Scars → occurs when healing wound under tension/poor healing due to ill health, specific health conditions or malnutrition

Treatment for Scars

  • factors that affect therapy → PATH : Predisposing & Causative Factors, Age of Scar & Anatomic Location, Type of Scar, family History → remember a LONG “PAATH”

  • Normal Scarring → recommend OTC products unless severe

  • Severe Scarring → refer to physician for further personalized treatment

OTC products → Onion Extract/Allantoin Gel (Mederma) → Silicone Gel Sheet (Cica-care), Centella Asiatica Extract (Centellase) & Vitamin E

OTC Product

OTC Product

Instructions

Purpose

Precautions

Mederma

  • Massage into skin 3-4 times daily

  • new scar → 8 weeks after healing

  • existing → 6 months daily for 6 months

Silicone Gel Sheet

  • wash hands before & after , gently clean the scar with a mild soap and rinse with warm water, dry & take gel sheet from tray to apply.

  • Allow for small overlap around the skin and cut sheet to fit the area as necessary w/o stretching → store remainder in cool place.

  • 4 hours per day (1-2nd day)

  • 8 hours per day for the next 2 days , and increase 2 hrs per day till 12 hours is reached

  • 24 hours if possible

  • Wash Cica-care the scars and surrounding skin twice daily with mild soap and rinse.

  • Best results seen after 2-4 months

Flatten raised scar

Reduce Size, soften and fade red and raised scars

Relieves itching and discomfort

Use only on intact skin

Rash may develop due to poor hygiene or when applied too tight, reduce treatment to 12 hours then rest 12 hours — discontinue treatment if persists.

Centella Asiatica Extract

  • apply once or twice daily on affected area.

  • improves wound repair

  • Decrease inflammation

  • Modulating & Slowing Down excessive production of collagen

Vitamin E (cream/oil/capsule)

  • speeds up healing processes * lightens scars.

  • either 90% has no benefit/effect or worsen the cosmetic appearance of scars.

The Visual "Body Map" Method (Skin Discoloration)

Visualize a person from the top down to create a mental map of where these issues often occur:

  1. Forehead: Melasma (often appears on the brow).

  2. Cheeks: Old acne marks.

  3. Shoulders: Sun damage (freckles).

  4. Arms: Bug bites.

  5. Underarms: Underarm irritation.

  6. Knees: Skin trauma (scraped knees/scars).

Treatment: HULK → Hydroquinone, arbUtin, Licorice and Kojic Acid.

Medication/Drug

Instructions

Purpose/MOA

Advantages

Precautions

Side Effects

Hydroquinone

  • should only apply to dark spots and avoid normal surroundings

  • apply twice a day

  • stop applying when desired effects are a achieved

  • Sun protection is needed (> SPF 15)

  • interferes with production of melanin by inhibiting tyrosinase (type of amino acid (tyrosine) to remove epidermal hyperpigmentation

  • Damages melanocytes and melanosomes

  • 2%-4% concentrations

  • Ochronosis

  • Cancer-causing compound

  • blue-black or yellow-brown pigmentation on connective tissues, skin and cartilage

Arbutin

  • Tyrosinase inhibitor to prevent formation of melanin to remove/reduce epidermal hyperpigmentation

  • Better sensitive skin

  • Less irritation on skin

Licorice

  • Tyrosinase inhibitor to prevent formation of melanin to remove/reduce epidermal hyperpigmentation

Kojic Acid.

  • Tyrosinase inhibitor to prevent formation of melanin to remove/reduce epidermal hyperpigmentation