Skin scarring, like death and taxes, is unavoidable and is an unfortunate consequence of skin injury that will affect us all at some point or other in our lives.
Following surgery, either planned or accidental, scars are inevitable. At best, you will end up with a fine line scar that is flat and mostly asymptomatic but it will always be present, as a permanent mark and a reminder of the injury to your skin.
Beyond closing wounds neatly and minimising tension, current management of skin scarring is an afterthought. It mostly focuses on the application of topicals post scar formation, that are designed to enable scar moisturisation (keep moisture and hydration in the scar). They have no active ingredients and, beyond making scars feel more comfortable, the evidence to substantiate improved outcomes is surprisingly limited.
Wound healing is a complex process that tries to restore the integrity of injured skin as quickly as possible. Operations carried out on infants, still in the womb, leave no scars in the early gestation. Healing is fundamentally by regeneration. Before we are born the healing process changes to an inflammatory one. This has advantages as it is a quicker process than regeneration – important as we are exposed to issues like infection – but it has the disadvantage of leaving a permanent mark – a scar. At best this is a fine line, but, when the inflammatory process continues, scars can become itchy and painful and can thicken up and even create abnormal thickened raised lesions called hypertrophic and keloid scars.
Raised skin scars such as hypertrophic and keloid scars heal poorly and become clinically and pathologically abnormal, as well as become clinically challenging as they can continue to remain symptomatic.
However, the current management of these pathological scars is ill-defined. Therefore, improved evidence-based scar management is becoming critical.
Nevertheless, most current treatment strategies of the initial steps for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted therapy.
The ideal approach, however, we argue here, is to do the opposite and take an early intervention prior to skin injury in order to minimise the risk of developing a poor scar outcome. This is particularly relevant for those individuals undergoing elective/scheduled skin surgery as it is routinely arranged in advance, otherwise known as trauma by prior appointment as opposed to trauma by accident.
Previous studies using Solution for Scars (a unique vegan scar care cream by Science of Skin Ltd) have shown improvement in scar outcome when used on wounds that have healed, until the redness settles, while further improvement occurs when the cream is used around wounds, from the time of injury until healed, when the stitches are removed.
Pre-treating skin before injury, in anticipation of surgery, is a novel approach aimed at optimising skin scarring outcome. Its goal is to lead to a further significant improvement in the appearance and quality of surgically induced skin scars, which should impact across the whole surgical spectrum.
With an estimated 100 million patients being left with permanent scars, after elective surgery, in the developed world each year alone, scarless, or scar-free, wound healing has long been something of a Holy Grail for surgeons and wound healing scientists alike.
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