Why scars absolutely need to be treated
Unfortunately, scars almost always leave behind marks on the skin. However, good treatment options exist that can considerably improve the appearance and functioning of the areas where marks are left behind. There are many other reasons why scars should be treated besides aesthetic ones. For one thing, failure to treat scars can lead to hypersensitivity, itching, pain, skin stretching, tension and tissue adhesions. In addition, lack of treatment can lead to an impairment of function and movement in hands and joints, for example.
Depending on their location and severity, heavily raised and proliferating (hypertrophic) scars or bulging scars (keloids) in particular can also cause mental or emotional stress, or even trauma.
Scar treatment is most successful in the first two years after scar formation, which is why this time should also be used to improve the quality of the scar.
Reasons for scar treatment
- Prevention of impairment of function and movement
- Promotion of scar tissue flexibility
- Pain reduction
- Reduction of hypersensitivity and itching
- Improvement of appearance
- Prevention of mental or emotional effects (trauma)
What is the best way to treat scars?
Every scar is different, which is why scar treatment will vary depending on scar type, a scar’s location and other factors. In general, however, treatments usually involve different measures that complement one another.
Starting treatment soon after a medical procedure is necessary to achieve the best possible result. This way, maximum use can be made of the time in which the scar is active. For all types of scars, non-invasive (non-surgical) treatment options should therefore be started as soon as the wound has healed.
Scar revision may be necessary for scars that cause significant function and mobility restrictions. Depending on the characteristics of the scar, this revision can be carried out surgically or by using laser therapy etc.
The responsible specialist doctor will select the most suitable combination of different treatment methods in each case.
Treatment options
With regard to scar treatment and therapy, a basic distinction is made between non-invasive (or conservative) and invasive treatment methods. Conservative treatment involves all medicine-based treatment and physical therapy approaches. Invasive treatment refers to all measures that involve penetration of the body – i.e. the skin is severed. This mainly involves surgical procedures.
How does compression therapy work?
How does compression therapy work?
One possible treatment method in scar therapy is the application of pressure (compression) on the scarred area. This can be done using flat-knitted compression garments that are tailor-made for the respective part of the body. Compression has been used successfully in scar therapy for many years. Compression therapy can even benefit older scars as long as the scar in question is still active and is being supplied with blood.
Adjusting the compression garment
If the compression garment fits exactly, it exerts medically effective and constant pressure, considerably helping to improve the scar area. It shouldn’t be constrictive, but it shouldn’t slip either. Specially trained medical products suppliers will take body measurements, which will make it possible to manufacture a compression garment with a precise anatomical fit (such as ScarComfort). The measuring process also determines whether additional extra options like pressure pads need to be incorporated in order to achieve ideal and even pressure in the scarred area. Doctors will prescribe the right compression class – and thus the right pressure intensity – for the treatment in question .
The ideal fit for compression garments
Compression garments sit very close to the body, like a second skin. This is the only way to ensure that the desired pressure can be achieved. Particularly at the start of therapy, putting on and wearing the compression garment can therefore need some getting used to and can also sometimes be unpleasant in the case of relatively young scars. This should not put anyone off, as a satisfying result can only be achieved if one wears the compression garment continuously throughout the day and at night.
With a little practice and handy aids, putting on the garment will get easier with time and wearing it will increasingly become part of everyday life.
Effectiveness of compression therapy
Effectiveness of compression therapy
Fig. 1 Hypertrophic, bulging scar without compression
Fig. 2 Flattened scar beneath the compression garment
Once a wound has healed, compression therapy can begin. The even, broad-area pressure provided by compression garments can have numerous positive effects on the scarred area:
- Prevention of uncontrolled growth
- Prevention of scar hypertrophy
- Fading of the scar
- Softer scar tissue
- Reduction in scar thickness
- Protection of sensitive skin or the graft
- Reduction of itching in the scar area
- Reduction of potential pain
- Increased mobility of scars in joint areas
- Minimization of the risk of scar contractures and resulting joint stiffness
Pads made of silicone
Pads made of silicone
Siliconepadscan be worn under compression garments at points of the body where compression alone is not enough to build up the required pressure on the scar tissue. This can be the case on the ankle or in cleavage areas, for example.
Duration of compression therapy
Duration of compression therapy
The duration of compression therapy depends on several factors and can therefore range from six months to two years. The patient’s personal commitment to therapy and patience, as well as support and encouragement from family and friends, play a decisive role in the success of the therapy. Only by consistently wearing compression garments (as prescribed by a doctor) can good scar healing be achieved without functional limitations.
Other factors that influence the duration of therapy include:
- Severity of the scars
- Location and extent of the scars
- Individual differences in healing response
In many cases, compression therapy can help avoid the need for surgical scar correction. However, this must be decided on an individual basis, case by case.
Silicone therapy
Silicone therapy
Treating scars using silicone is another effective option in scar therapy. Silicone retains the skin’s natural moisture, preventing the scar area from drying out. Silicone products are made of 100% medical silicone. They are soft, highly elastic and very adaptable, which means people find the wearing experience to be pleasant rather than disruptive. Compression pads – like the Juzo ScarPad – are self-adhesive and can be worn either alone or in combination with a compression garment. Other silicone products – like Juzo Silon®-TEX – are sewn directly into the compression garment. Using silicone products early in conjunction with compression therapy can be an ideal supplement and can boost therapeutic effectiveness:
- Improvement in the softness of scar tissue
- Reduction of uncontrolled and excessive growth of the scar
- Additional protection of fresh scar tissue or skin grafts
- Prevention of direct rubbing on the skin
Silicone products are not used until a wound has closed completely. It’s important to clean silicone sheets on a regular basis in order to ensure proper hygiene and prevent irritation of the sensitive newly formed skin.
Physical therapy and occupational therapy
Physical therapy and occupational therapy
The replacement tissue in a scar unfortunately does not display all the characteristics of the original skin. Scar tissue on hands and feet especially, but also on all joints, can result in restricted mobility and functionality. The main goal of physiotherapy-based scar treatment is to maintain mobility and functionality as much as possible, or to restore such mobility and functionality as has been lost. The use of manual movement and massage techniques improves regional circulation, loosens adhesions from structures underneath the skin, reduces feelings of tension and hypersensitivity and generally makes scars softer and more elastic.
Scar care
Scar care
One can begin scar care themselves once a wound has closed completely. Because scar tissue tends to dry out, creams and gels with a silicone additive are recommended for scar care. These creams and gels form a thin film on the scar surface and keep the scar from drying out. Rubbing in these products intensively and regularly makes the scar tissue more flexible and more supple.
In order to prevent inflammation, the scar area should be cleaned on a regular basis and always kept hygienically clean.
There are numerous invasive treatment methods that can be used in line with different scar types and treatment goals. Whereas some methods are geared mainly towards restoring mobility and functionality, others are designed primarily to remove or reduce visible deformations and noticeable skin changes.
Surgical scar removal
Relatively small scars, hypertrophic scars and keloids can be surgically removed. The gaps that form as a result are usually filled with surrounding tissue.
A diverse range of treatment options are available for larger scars as well. In a serial excision, larger gaps are closed gradually in several surgical procedures. Alternatively, missing skin can be replaced by skin taken from another part of the body.
Full-thickness skin grafts (skin grafts consisting of an area of skin detached in the subcutis, with a complete epidermis component) are used in most cases for the face and areas subject to particular stress, such as joints. On the other hand, split-thickness skin grafts are often used when wounds are deep and extensive. These skin grafts use only the outer layer of the skin and parts of the middle layer. The grafts here can also be cut additionally and then fanned out like a net in order to cover a larger area.
Dermabrasion
Dermabrasion
In this procedure, the outermost layer of skin (the epidermis) is removed using a rotating, diamond-tipped grinding head under local anaesthetic. The method is mainly used to treat acne scars in order to improve the appearance of the skin.
Microneedling
Microneedling
Microneedling involves perforating the skin using a roller fitted with fine needles. This creates numerous tiny injuries, which trigger repair and growth processes. Microneedling is not recommended for people prone to keloid formation, in order to avoid the possibility of new keloids developing.
Subcutaneous injections (filler)
Subcutaneous injections (filler)
In particular, sunken scars, such as those caused by severe acne, can be filled in using collagen, hyaluronic acid or the patient’s own fat.
Cortisone injections
Cortisone injections
Glucocorticoid injections are used to reduce excessive scar growth caused by increased connective tissue production in cases of hypertrophic scars and keloids.
Laser treatment
Laser treatment
There are various types of laser treatment available for treating scars, enabling different types of scars to be treated in a targeted manner. The high-energy laser light causes thermal damage to the tissue, which removes the scar tissue and reduces discolouration. The procedures used include vascular lasers, pigment lasers and fractional lasers (Fraxel lasers).
Cryotherapy
Cryotherapy
In cryotherapy, hypertrophic scars and keloids are frozen using liquid nitrogen, causing parts of the excess tissue to die off and the scar as a whole to shrink and become flatter. Depending on the method used, the nitrogen is either applied to the scar from the outside or injected directly into the scar tissue using a special needle.
Radiation therapy
Radiation therapy
In the case of keloids that do not respond to standard forms of treatment, early radiation therapy using superficial X-rays can halt the progression of uncontrolled growth and may even lead to partial regression.
Possible invasive treatment methods, depending on the type of scar in question
| Hypertrophic scars (raised scars) | Keloids (bulging tissue proliferation) | Atrophic scars (sunken scars, acne scars) | Sclerotic scars (shrunken scars) | |
|---|---|---|---|---|
| Surgical scar removal | + | + | + | |
| Dermabrasion | + | + | ||
| Microneedling | + | |||
| Subcutaneous injections | + | |||
| Cortisone injections | + | + | ||
| Laser treatment | + | in combination with surgical removal | + | |
| Cryotherapy | + | + | ||
| Radiation therapy | + |
Tips for successful scar treatment and therapy
We have put together a few helpful tips that can promote the success of your scar therapy. It is often the small things that don’t require too much effort that can support the progress of therapy and make treatment easier for you.
Wearing period
Wearing period
Sunlight
Sunlight
Cleaning compression garments
Cleaning compression garments
Physical therapy / occupational therapy
Physical therapy / occupational therapy
Cleaning silicone sheets
Cleaning silicone sheets
Scar care
Scar care
Fit
Fit
Open wounds
Open wounds
Wear your compression garment exactly as prescribed by your doctor. This is the only way to guarantee an optimum treatment outcome. Normally, your garment should also be worn at night and only removed when it needs to be washed.
Do not expose your scars to direct sunlight and protect yourself sufficiently with sun cream. Direct sunlight promotes the formation of hypertrophic scars. The scar tissue can also darken. Compression garments from Juzo (Juzo ScarComfort) guarantee you UV Protection Factor UPF 30. Juzo silicone sheets (Juzo ScarPad) offer additional protection as they have a UV Protection Factor of UPF 50.
Your compression garment can be washed in the washing machine on a gentle or delicate wash cycle (40°C or less). Residue of skin scaling, ointments, dirt and dust particles can collect in the fabric. You should therefore wash your compression garment every day – this is the only way to ensure that the elastic properties will be retained over the long term, and it will also increase your compression garment’s already high level of durability. We recommend using the gentle Juzo special detergent every time you wash your garment. Please do not use any fabric softener as the plasticisers it contains damage the compression fabrics!
Targeted movement through physical and occupational therapy plays an important role in the effectiveness of scar therapy. Such movement mobilises the scar tissue and improves circulation, making the connective tissue softer. Furthermore, it allows joint deformities or limb stiffening to be treated in the best possible way, leading to the achievement of optimum results. Always follow the treatment recommendations provided by your doctor.
Clean your ScarPad every day – this is the only way to ensure the hygiene required in the scar area and that the product remains firmly in place. The ScarPad should be washed using a special soap (Juzo ScarPad Cleaning Soap). Put a couple of drops of the soap onto the ScarPad and wash it thoroughly under warm running water. After cleaning it, place it on a dry towel with the sticky side facing upwards. It is ready to be used again when it has completely dried.
Scarred skin can be kept supple by massaging it and applying a cream every day. Hygiene is very important here: keep the scar area clean to prevent inflammation. Follow the skincare recommendations provided by your doctor.
Compression garments must fit perfectly and should not be constrictive or slip. Body measurements may change due to weight gain or loss, or due to growth in children. In this case, please consult your medical retailer. They will check the fit of the garment and, if required, measure a new garment for you.
Silicone sheets must never be worn on open wounds! Be sure to consult your doctor before wearing compression garments over existing wounds. If your doctor approves, compression garments may be worn on smaller wounds over a bandage or dressing. Compression can help residual defects to heal particularly quickly and without any complications.
Putting on garments and ensuring the right fit
Why does a scar-care garment have to be so tight?
Why does a scar-care garment have to be so tight?
The term compression garment itself indicates that the effect it has is a result of pressure (compression). Here, pressure affects scars in such a way that the new tissue that forms is arranged in the most structured manner possible and doesn’t proliferate uncontrollably. The scar thus remains flatter, softer and also more flexible than would otherwise be the case. In addition, scar-care garments serve as a type of protective layer during the initial healing phase, and they also reduce scar itching.
Is it normal that compression garments leave marks after they are removed?
Is it normal that compression garments leave marks after they are removed?
Compression decongests tissue. This effect becomes much more visible after a compression garment is removed. Marks are completely normal and they also show that the compression is having the intended effect.
Scar care
Should cream be applied to skin under a scar-care garment?
Should cream be applied to skin under a scar-care garment?
Scars should not be allowed to dry out. Scarred skin can be kept supple by massaging a cream into it every day. We recommend the use of specially designed care products such as moisturising Juzo Lymph Lotion with 4% urea and 30% lipids.
Is it also okay to use ointments that contain paraffins?
Is it also okay to use ointments that contain paraffins?
A compression garment should not be put on again until ointments that contain paraffins have been completely absorbed.
Which scar creams does it make sense to use?
Which scar creams does it make sense to use?
Creams that contain silicone prevent scars from drying out and thus support the healing process.
Is it okay to use soap when you wash if you have a scar?
Is it okay to use soap when you wash if you have a scar?
Once a wound has completely healed, scars should also be washed with soap for hygienic reasons. After washing, a lipid replenishing cream should be applied to ensure the scar does not dry out too much.
Duration of wearing; replacing garments
How frequently will a new garment be provided?
How frequently will a new garment be provided?
Two garments are provided every year. More than one garment is needed because the garments should be worn 24 hours a day and also have to be washed every day. A new garment can be prescribed if an old garment no longer fits because the person has grown or gained or lost weight.
How can one manage to wear only one garment for 23 hours, given the fact that the garment has to be washed and dried every day?
How can one manage to wear only one garment for 23 hours, given the fact that the garment has to be washed and dried every day?
As a rule, garments should be switched for hygiene reasons. Talk to your supplier and/or doctor.
What can one do if the compression garment breaks or is severely damaged?
What can one do if the compression garment breaks or is severely damaged?
A request for a new garment should be submitted to the doctor or supplier for forwarding to the health insurance provider. A frank discussion with the customer service representative at your health insurance provider can be helpful here in terms of obtaining approval for a new garment.
How long should compression garments be worn?
How long should compression garments be worn?
Scars remain active for up to two years after they form. It makes sense to use compression garments during this time. Scars that have faded and are no longer red are referred to as inactive scars. Such scars no longer change very much.
Why do compression garments have to be worn around the clock?
Why do compression garments have to be worn around the clock?
Only if continuous pressure is placed on the scar will the newly formed connective tissue remain soft and flat.
Washing and material care
How often do compression garments have to be washed?
How often do compression garments have to be washed?
Compression garments must be washed every day.
How should one wash compression garments?
How should one wash compression garments?
Your compression garment can be washed by hand or in the washing machine on a gentle or delicate wash cycle (40°C or less). Make sure to use either a special detergent or a detergent for delicate fabrics (without a fabric softener).
Is it okay to use skin cream underneath a silicone sheet?
Is it okay to use skin cream underneath a silicone sheet?
Skin cream is an important part of scar care, as it keeps scars soft and supple. However, the cream needs to be fully absorbed by the skin before a silicone sheet can be put on again.
Silicone sheets
How do you clean silicone sheets?
How do you clean silicone sheets?
If the silicone sheet has an adhesive (sticky) side, you can clean it with warm water and soap and then hang it up to dry in an area free of dust. Specially produced silicone sheets and pads can and should additionally be placed in boiling water for a few minutes every two days.
Is it normal that silicone sheets leave marks after they are removed?
Is it normal that silicone sheets leave marks after they are removed?
It’s normal that the compression effect serves to decongest tissue and that impressions of the silicone sheet can be seen on the skin.
Miscellaneous
Do compression garments prevent sunlight from getting through?
Do compression garments prevent sunlight from getting through?
The sun protection effect depends on the material used in each case. Juzo ScarComfort compression garments, for example, guarantee a UV Protection Factor of UPF 30. Juzo ScarPad silicone sheets offer additional protection, as they have a UV Protection Factor of UPF 50.
When can a person with a scar start taking baths and showers again, or go swimming?
When can a person with a scar start taking baths and showers again, or go swimming?
After the wound has healed.
When is physiotherapy or occupational therapy prescribed within the framework of scar treatment?
When is physiotherapy or occupational therapy prescribed within the framework of scar treatment?
Large scars located near or on joints in particular can lead to impairment of function and movement. You should talk about this with your doctor.
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