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Treatment of scars, freckles, wrinkles

Injuries of dermis (middle layer of the skin) sometimes heal leaving pathologic scars behind. Scars are moderate, if the dermis is only superficially injured. Scars are overgrown, if the dermis is deeply injured. Those overgrown, so called “hypertrophic” scars are of irregular shape; they are reddish-purplish and rise above the surrounding skin. Often thicken for months and itch. They do not extend beyond the boundary of the original wound (burning, deep bruises, infected surgical wound). Predisposing factors may be: adolescence, pregnancy-afterbirth period; anatomical location; as chest,breastbone, back, neck, earlobes etc.When surgical incision is made towards the direction of muscle movements, the overgrowth of the scars may be predicted, because motion stimuli prevent the scars from atrophying. A wound above the elbow joint, parallel with the vertical axis of the upper limb, is permanently affected by motion stimuli. Hypertrophy speeds up, if there are strong motion stimuli, such as exercises or physical activity. Many other well known risk factors play role in scar hypertrophy.For example: some skin types, disorders of connective tissues, hormonal and metabolism disorders, trace-element or vitamin deficiencies etc. are predisposing to hypertrophic scarring.

The so called “scar question” is the first to discuss with the patient when planning aesthetical surgeries. The aim is not only to avoid pathologic scarring, but to hide them in crinkles, wrinkles, folds and make them fine, soft, scrape or wrinkle-like. The most severe form of the pathologic scars is the keloid. Unfortunately, its causes are still unknown. There is a thorough knowledge of the above causes and predisposing factors along with important clinical research documentation. First step of the keloid treatment is to prevent further growth. Compression treatment, when the patient wears an appropriately shaped tubular bandage 8-10 hours a day, for some weeks. If the result is not satisfactory, next step is the application of a silicone gel patch to the hypertrophic scar. In most of the cases it is applied by night, it can be fixed with adhesive tape, if necessary. The patches cannot be fixed to the uneven surface of some body parts; in this case crème- gel is used. The crème hardens after application and it is to be covered with foil. According to the latest researches silicone gel patches are increasing moisture content of the scars, hindering evaporation of the tissues. Contratubex crème is generally used as a supplementary treatment before and after scar excision. Contratubex softens and remodels the scars. After these treatments the keloid may be surgically removed. In some more severe cases (e.g. repeated recurrence) steroid is injected into the scar before, during and after the surgery.