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Hypertrophic scar management

02 March 2023
Clinical
02 March 2023
Volume 12 · Issue 2

Abstract

Scarring has major psychological and physical repercussions. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. It is more efficient to prevent hypertrophic scars than treat them; early diagnosis of a problem scar can considerably impact the overall outcome. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.

Over 100 million people develop scars in the developed world alone each year because of 55 million elective and 25 million trauma operations (Gauglitz et al, 2011). Wound healing is a complex process that is described as taking place over three main phases: inflammation, proliferation and remodelling. According to Trace et al (2016), it is during the remodelling phase that collagen deposition occurs in an organised fashion that results in a normal scar.

Abnormal scarring occurs when there is a disruption in this process that can lead to excess collagen synthesis and deposition that results in a hypertrophic scar (De Decker et al, 2022). During the formation of scars, the epidermal layers of the skin will produce high levels of moisture in an attempt to hydrate the scar site. However, most of this moisture evaporates once it reaches the stratum corneum, or upper layer of the skin; this is due to damage to the stratum corneum (De Decker et al, 2022). This moisture loss triggers keratinocytes in the skin to produce collagen, leading to this disruption.

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Scars
Scarring
Hypertrophic scarring
Scar management
Silicone therapy