Scars & Skin Lesions

Scars and Skin Lesions
Mr Nduka has a special interest in scar prevention and has published research in this field. He established with colleagues at the Royal London Hospital the first nurse-led Scar Management clinic in the country and the protocol was adopted by the NHS Modernisation Agency.

What are Scars?
Scar formation is a natural part of the healing process and it occurs after almost every skin injury. The more the skin is damaged, the longer it takes to heal and, as a consequence, the greater chance that a patient will be left with a noticeable scar. In most cases, healing progresses normally and the patient is left with a scar that causes no further problems. In the ideal situation a mature scar is thin, pale, flat, and causes no symptoms. This maturation process takes approximately 18 months. However, some people develop abnormal scars that may be disfiguring and aesthetically unpleasant. These scars can also be symptomatic causing itching, tenderness, pain, sleep disturbance, anxiety, depression, and disruption of normal daily activities.

Atrophic scars
Some scars are pitted, for example after acne or chickenpox. These are so-called atrophic scars where there is a loss of collagen and volume. These scars are generally small, round depressions that lie below the surface of the surrounding skin. They are formed when the healing process is disrupted.

Hypertrophic scars
These scars are more common in the young, following burns and in people with darker skin. These scars are usually red, thick and elevated and can be itchy or painful, but their growth is confined within the boundaries of the original wound. Hypertrophic scars usually start to develop within weeks after the injury and may improve naturally, although this process can take up to a year or more.

Keloid scars
Keloids may occur at any age, but tend to develop more readily in younger individuals and in darker-skinned people. These are thick, rounded, irregular clusters of scar tissue that extend beyond the original wound. They often appear red or darker in colour compared with the surrounding skin. Keloids may not develop for many months after injury, and may also worsen during pregnancy. Options for treating problem scars can be non-surgical or by scar revision.

Non surgical options
Non surgical options include the use of topical silicone ointments or sheeting, or by injecting the scars with anti-scarring agents. Larger areas may be treatable by use of laser or intense pulsed light (IPL) therapy.

Laser and IPL therapies work by targeting intense light onto the skin. Light is focussed onto the area around the scar or blemish. The IPL or laser light then penetrates through the upper layer of your skin, effectively burning it off. The treatment stimulates new skin to grow, and when the treated area heals, the scar or blemish is usually much less noticeable than before.

Following scar treatment by laser or IPL, your skin will be red and weepy, and redness will probably persist for several weeks. You will need to use sunblock on the area for at least six months after treatment. The full results of your laser or IPL treatment will not usually be seen until 10-12 months afterwards. You may be recommended further therapy six to 12 months after your first treatment.

Lasers can cause an uneven colour in brown and black skins so the treatment may not be suitable for people with these skin types.

The effectiveness of laser or IPL therapies for acne scar treatment and skin blemishes depends both on your skin type and on the extent and type of your scars. Often laser and IPL are used in conjunction with other cosmetic procedures to achieve the best results. Mr Nduka will advise if laser treatment is suitable for you and refer you to an appropriate practitioner.

Scar revision
Scar revision aims to excise the problematic scar and replace it with a fresh scar. The new scar is carefully positioned and sutured using techniques that aim to reduce the risk of recurrence. In some cases the scar direction can be changed to lie in natural skin creases. Drugs may be injected into the scar at the time of surgery to minimize the chance of keloid formation. Troublesome keloids may require several injections every few weeks to keep scar formation under control. Usually Mr Nduka will recommend that the scar is supported with surgical tape for a prolonged duration after surgery to reduce the tension o the scar.