Editing Scar (section)

== Treatment ==
Early and effective treatment of acne scarring can prevent severe acne and the scarring that often follows.<ref>{{cite web | title = What is a Scar | url = http://www.aad.org/public/publications/pamphlets/cosmetic_scar.html | publisher = American Academy of Dermatology | quote = Early and effective acne treatment can prevent severe acne and the scarring that often follows | year = 2011 | access-date = 25 August 2011 | archive-date = 12 February 2011 | archive-url = https://web.archive.org/web/20110212180603/http://www.aad.org/public/publications/pamphlets/cosmetic_scar.html | url-status = dead }}</ref> In 2004, no prescription drugs for the treatment or prevention of scars were available.<ref>{{cite journal |vauthors=Ferguson MW, O'Kane S | title = Scar-free healing: from embryonic mechanisms to adult therapeutic intervention | journal = Philos. Trans. R. Soc. Lond. B Biol. Sci. | volume = 359 | issue = 1445 | pages = 839–50 | date = May 2004 | pmid = 15293811 | pmc = 1693363 | doi = 10.1098/rstb.2004.1475 }}</ref>

=== Chemical peels ===
Chemical peels are chemicals which destroy the epidermis in a controlled manner, leading to exfoliation and the alleviation of certain skin conditions, including superficial acne scars.<ref>{{cite journal | author = Khunger N | title = Standard guidelines of care for acne surgery | journal = Indian Journal of Dermatology, Venereology and Leprology | volume = 74 Suppl | pages = S28–36 | date = January 2008 | pmid = 18688101 | url = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2008;volume=74;issue=7;spage=28;epage=36;aulast=Khunger }}</ref> Various chemicals can be used depending upon the depth of the peel, and caution should be used, particularly for dark-skinned individuals and those individuals susceptible to [[keloid]] formation or with active infections.<ref>{{cite journal | author = Khunger N | title = Standard guidelines of care for chemical peels | journal = Indian Journal of Dermatology, Venereology and Leprology | volume = 74 Suppl | pages = S5–12 | date = January 2008 | pmid = 18688104 | url = http://www.ijdvl.com/article.asp?issn=0378-6323;year=2008;volume=74;issue=7;spage=5;epage=12;aulast=Khunger }}</ref>

=== Filler injections ===
Filler injections of [[collagen]] can be used to raise [[Atrophy|atrophic]] scars to the level of surrounding skin.<ref>{{cite journal |vauthors=Cooper JS, Lee BT | title = Treatment of facial scarring: lasers, filler, and nonoperative techniques | journal = Facial Plastic Surgery | volume = 25 | issue = 5 | pages = 311–5 | date = December 2009 | pmid = 20024872 | doi = 10.1055/s-0029-1243079 | s2cid = 260136591 }}</ref> Risks vary based upon the filler used, and can include further disfigurement and [[allergic reaction]].<ref>{{cite journal |vauthors=Lemperle G, Rullan PP, Gauthier-Hazan N | title = Avoiding and treating dermal filler complications | journal = Plastic and Reconstructive Surgery | volume = 118 | issue = 3 Suppl | pages = 92S–107S | date = September 2006 | pmid = 16936549 | doi = 10.1097/01.prs.0000234672.69287.77 | s2cid = 32471639 | url = http://www.escholarship.org/uc/item/4t0019d6 }}</ref>

=== Laser treatment ===
Nonablative lasers, such as the 585&nbsp;nm [[pulsed dye laser]], 1064&nbsp;nm and 1320&nbsp;nm [[Nd:YAG]], or the 1540&nbsp;nm [[Er:glass laser|Er:Glass]] are used as laser therapy for hypertrophic scars and keloids.<ref name="pmid21061757">{{cite journal |vauthors=Elsaie ML, Choudhary S |title=Lasers for scars: A review and evidence-based appraisal |journal=Journal of Drugs in Dermatology |volume=9 |issue=11 |pages=1355–62 |date=November 2010 |pmid=21061757}}</ref> There is tentative evidence for burn scars that they improve the appearance.<ref>{{cite journal |last1=Willows |first1=B.M. |last2=Ilyas |first2=M. |last3=Sharma |first3=A. |title=Laser in the management of burn scars |journal=Burns |date=4 August 2017 |doi=10.1016/j.burns.2017.07.001 |pmid=28784339 |volume=43 |issue=7 |pages=1379–1389}}</ref><ref>{{cite journal |last1=Friedstat |first1=JS |last2=Hultman |first2=CS |title=Hypertrophic burn scar management: what does the evidence show? A systematic review of randomized controlled trials. |journal=Annals of Plastic Surgery |date=2014 |volume=72 |issue=6 |pages=S198–201 |doi=10.1097/SAP.0000000000000103 |pmid=24835874|s2cid=47573176 }}</ref>

Ablative lasers such as the [[carbon dioxide laser]] (CO{{sub|2}}) or [[Er:YAG]] offer the best results for atrophic and acne scars.<ref>{{cite journal |vauthors=Khatri KA, Mahoney DL, McCartney MJ |title=Laser scar revision: A review |journal=Journal of Cosmetic and Laser Therapy |volume=13 |issue=2 |pages=54–62 |date=April 2011 |pmid=21401378 |doi=10.3109/14764172.2011.564625|s2cid=11520661 }}</ref> Like [[dermabrasion]], ablative lasers work by removing the epidermis.<ref>{{Citation |last1=Verma |first1=Neil |title=Ablative Laser Resurfacing |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK557474/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491406 |access-date=2022-07-21 |last2=Yumeen |first2=Sara |last3=Raggio |first3=Blake S.}}</ref><ref>{{Cite web |title=Laser resurfacing |url=https://www.mayoclinic.org/tests-procedures/laser-resurfacing/about/pac-20385114 |access-date=2022-07-21 |website=Mayo Clinic |language=en}}</ref> Healing times for ablative therapy are much longer and the risk profile is greater compared to nonablative therapy; however, nonablative therapy offers only minor improvements in cosmetic appearance of atrophic and acne scars.<ref name="pmid21061757"/>

=== Radiotherapy ===
Low-dose, superficial [[radiotherapy]] is sometimes used to prevent recurrence of severe keloid and hypertrophic scarring. It is thought to be effective despite a lack of clinical trials, but only used in extreme cases due to the perceived risk of long-term side effects.<ref>{{cite journal |vauthors=Ogawa R, Yoshitatsu S, Yoshida K, Miyashita T | title = Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis | journal = Plastic and Reconstructive Surgery | volume = 124 | issue = 4 | pages = 1196–201 | date = October 2009 | pmid = 19935303 | doi = 10.1097/PRS.0b013e3181b5a3ae | s2cid = 25294698 }}</ref>

=== Dressings and topical silicone===
Silicone scar treatments are commonly used in preventing scar formation and improving existing scar appearance.<ref>{{cite journal |vauthors=Stavrou D, Weissman O, Winkler E, Yankelson L, Millet E, Mushin OP, Liran A, Haik J | title = Silicone-based scar therapy: a review of the literature | journal = Aesthetic Plastic Surgery | volume = 34 | issue = 5 | pages = 646–51 | date = October 2010 | pmid = 20354695 | doi = 10.1007/s00266-010-9496-8 | s2cid = 43820233 }}</ref> A [[Meta-analysis|meta-study]] by [[Cochrane (organisation)|the Cochrane collaboration]] found weak evidence that [[silicone gel sheeting]] helps prevent scarring.<ref name=Ob2013/> However, the studies examining it were of poor quality and susceptible to bias.<ref name=Ob2013>{{cite journal|last1=O'Brien|first1=L|last2=Jones|first2=DJ|title=Silicone gel sheeting for preventing and treating hypertrophic and keloid scars.|journal=The Cochrane Database of Systematic Reviews|date=12 September 2013|volume=9|issue=9|pages=CD003826|pmid=24030657|doi=10.1002/14651858.CD003826.pub3|pmc=7156908}}</ref>

[[Pressure dressing]]s are commonly used in managing burn and hypertrophic scars, although supporting evidence is lacking.<ref name=Shih2007>{{cite journal |vauthors=Shih R, Waltzman J, Evans GR | title = Review of over-the-counter topical scar treatment products | journal = Plastic and Reconstructive Surgery | volume = 119 | issue = 3 | pages = 1091–5 | date = March 2007 | pmid = 17312518 | doi = 10.1097/01.prs.0000255814.75012.35 | s2cid = 2756632 }}</ref> Care providers commonly report improvements, however, and pressure therapy has been effective in treating ear keloids.<ref name=Shih2007/> The general acceptance of the treatment as effective may prevent it from being further studied in clinical trials.<ref name=Shih2007/>

=== Verapamil-containing silicone gel ===
[[Verapamil]], a type of calcium channel blocker, is considered a candidate drug for the treatment of hypertrophic scars. A study conducted by the [[Catholic University of Korea]] concluded that verapamil-releasing silicone gel is effective and is a superior alternative to the conventional silicone gel where decreased median SEI, fibroblast count, and collagen density in all verapamil-added treatment groups were observed.<ref name="wound journal">{{Cite journal |last1=Choi |first1=Jangyoun |last2=Han |first2=Yu Na |last3=Rha |first3=Eun Young |last4=Kang |first4=Hwi Ju |last5=Kim |first5=Ki Joo |last6=Park |first6=Il Kyu |last7=Kim |first7=Hyun-Jung |last8=Rhie |first8=Jong Won |date=2021-03-17 |title=Verapamil-containing silicone gel reduces scar hypertrophy |journal=International Wound Journal |volume=18 |issue=5 |pages=647–656 |doi=10.1111/iwj.13566 |issn=1742-4801 |pmc=8450805 |pmid=33733593}}</ref>{{rp|647–656}} Gross morphologic features suggested that the combination of verapamil and silicone improves the overall quality of hypertrophic scars by reducing scar height and redness. This was verified with quantifiable histomorphometric parameters; however, oral verapamil is not a good choice because of its effect of lowering blood pressure. Intralesional injection of verapamil is also suboptimal because of the required frequency for injections. Topical silicone gel combined with verapamil does not lead to systemic hypotension, is convenient to apply, and shows enhanced results.<ref name="wound journal"/>{{rp|647–656}}

=== Steroids ===
A long-term course of [[corticosteroid]] injections into the scar may help flatten and soften the appearance of keloid or hypertrophic scars.<ref>{{cite journal |vauthors=Roques C, Téot L | title = The Use of Corticosteroids to Treat Keloids: A Review | journal = The International Journal of Lower Extremity Wounds | volume = 7 | issue = 3 | pages = 137–145 | year = 2008 | pmid = 18611924 | doi = 10.1177/1534734608320786 | s2cid = 9577277 }}</ref>

Topical steroids are ineffective.<ref name="ReferenceB">Jenkins M, Alexander JW, MacMillan BG, Waymack JP, Kopcha R. Failure of topical steroids and vitamin E to reduce postoperative scar formation following reconstructive surgery. J Burn Care Rehabil. 1986 Jul–Aug;7(4):309–312.</ref> However, [[clobetasol propionate]] can be used as an alternative treatment for keloid scars.<ref>{{Cite journal | title=A Randomized, Single-Blind Trial of Clobetasol Propionate 0.05% Cream Under Silicone Dressing Occlusion Versus Intra-Lesional Triamcinolone for Treatment of Keloid | journal=Clinical Drug Investigation | volume=37 | issue=3 | pages=295–301 | date=2016-11-25 | pmid=27888448 | last1=Nor | first1=N. M. | last2=Ismail | first2=R. | last3=Jamil | first3=A. | last4=Shah | first4=S. A. | last5=Imran | first5=F. H. | doi=10.1007/s40261-016-0484-x | s2cid=33614354 }}</ref>

Topical steroid applied immediately after fractionated {{CO2}} laser treatment is however very effective (and more efficacious than laser treatment alone) and has shown benefit in numerous clinical studies.

=== Surgery ===
[[File:scar revision.jpg|right|thumb|Scarring caused by [[Acne vulgaris|acne]] (left), and photo one day after scar revision surgery: The area around sutures is still swollen from surgery.]]

Scar revision is a process of cutting the scar tissue out. After the excision, the new wound is usually closed up to heal by [[primary intention]], instead of [[secondary intention]]. Deeper cuts need a multilayered closure to heal optimally, otherwise depressed or dented scars can result.<ref name=scarrevision2010>{{Cite web  | title = Scar revisions  | quote = Deep cuts need multi-layered closure to heal optimally; otherwise, depressed or dented scars can result  | url = http://www.haplasticsurgery.com/scar-revision-surgery-dallas-texas.html  | access-date = 16 October 2010  | archive-url = https://web.archive.org/web/20120119050557/http://www.haplasticsurgery.com/scar-revision-surgery-dallas-texas.html  | archive-date = 19 January 2012  | url-status = dead  | df = dmy-all  }}</ref>

Surgical excision of hypertrophic or keloid scars is often associated to other methods, such as pressotherapy or silicone gel sheeting. Lone excision of keloid scars, however, shows a recurrence rate close to 45%. A clinical study is currently ongoing to assess the benefits of a treatment combining surgery and laser-assisted healing in hypertrophic or keloid scars.

''Subcision'' is a process used to treat deep rolling scars left behind by [[Acne vulgaris|acne]] or other skin diseases. It is also used to lessen the appearance of severe [[glabella]] lines, though its effectiveness in this application is debatable. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as [[laser resurfacing]], [[microdermabrasion]] or [[chemical peel]]s can be used to smooth out the scarred tissue.<ref>{{Cite web|date=2014-09-17|title=Chemical peels vs laser peels vs microdermabrasion: which one is right for you?|url=https://www.bclaserandskincare.com/2014/09/lasers-chemical-peels/|access-date=2021-06-24|website=Beautiful Canadian Laser and Skincare Clinic|language=en-CA}}</ref>

===Vitamins===
Research shows the use of [[vitamin E]] and onion extract (sold as [[Mederma]]) as treatments for scars is ineffective.<ref name=Shih2007/> Vitamin E causes contact [[dermatitis]] in up to 33% of users and in some cases it may worsen scar appearance and could cause minor skin irritations,<ref name="ReferenceB"/> but [[Vitamin C]] and some of its [[esters]] fade the dark pigment associated with some scars.<ref name="ReferenceA">Farris PK. Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Although many people claim that vitamin therapy does in fact help. Dermatol Surg 2005;31:814-818.</ref>

===Other===
* Cosmetics; Medical makeup can temporarily conceal scars.<ref>{{Cite journal|title = Medical Makeup for Concealing Facial Scars|url = http://pubs.bli.uci.edu/sites/default/files/publications/s-0032-1325647.pdf|journal = Facial Plastic Surgery|date = 2012-10-01|pages = 536–540|volume = 28|issue = 5|doi = 10.1055/s-0032-1325647|language = en|first1 = Donna|last1 = Mee|first2 = Brian|last2 = Wong|pmid = 23027221|s2cid = 23900892|access-date = 30 January 2016|archive-date = 5 October 2016|archive-url = https://web.archive.org/web/20161005230125/http://pubs.bli.uci.edu/sites/default/files/publications/s-0032-1325647.pdf|url-status = dead}}</ref> This is most commonly used for [[Face|facial]] scars.
* [[Dermabrasion]] involves the removal of the surface of the skin with special equipment, and usually involves a [[local anaesthetic]].
* A 2012 literature review found weak evidence that [[massage]] was efficacious in scar management. Any beneficial effect appeared to be greater in wounds created by [[surgical incision]] than for traumatic or [[burn]] wounds.<ref name="ShinBordeaux2012">{{cite journal|last1=Shin|first1=Thuzar M.|last2=Bordeaux|first2=Jeremy S.|title=The Role of Massage in Scar Management: A Literature Review|journal=Dermatologic Surgery|volume=38|issue=3|year=2012|pages=414–423|issn=1076-0512|doi=10.1111/j.1524-4725.2011.02201.x|pmid=22093081|s2cid=1018590}}</ref> A 2022 scoping review covering twenty-five studies of  1515 participants reported that all studies reviewed reported favorable outcomes for scar massage, but that "while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics", there was a lack of "consistent research methods, intervention protocols and outcome measures".<ref>{{cite journal | last1=Scott | first1=Helen C. | last2=Stockdale | first2=Claire | last3=Robinson | first3=Andrea | last4=Robinson | first4=Luke S | last5=Brown | first5=Ted | title=Is massage an effective intervention in the management of post-operative scarring? A scoping review | journal=Journal of Hand Therapy | volume=35 | issue=2 | date=2022 | doi=10.1016/j.jht.2022.01.004 | pages=186–199| pmid=35227556 }}</ref>
* [[Microneedling]]<ref>{{cite journal|last1=Cohen|first1=BE|last2=Elbuluk|first2=N|title=Microneedling in skin of color: A review of uses and efficacy.|journal=Journal of the American Academy of Dermatology|date=February 2016|volume=74|issue=2|pages=348–55|pmid=26549251|doi=10.1016/j.jaad.2015.09.024}}</ref>