What does it mean when scars itch

Which helps with painful or itchy scars

A surgical procedure, a deep cut with a knife or a piece of glass into the tissue - and a scar is created. Scars are the result of the wound healing process. The fiber-rich substitute tissue is, however, inferior to healthy skin. Some people literally feel this inferiority for a long time: the scar is painful or itchy, especially at night, and there is a kind of foreign body sensation. Sometimes scars can also lead to functional impairments. All of this can create high levels of suffering. Dermatologists say that abnormal scars need treatment. But what helps against the pain and itching?

"There is no first-choice treatment method for scars; each therapy goal must be determined individually with the patient," explains Professor Dr. Uwe Paasch, dermatologist at the University of Leipzig. The updated S2k guideline "Treatment of pathological scars" by the German Dermatological Society (DDG) shows which therapeutic options are recommended.

Red raised scars can be a major discomfort

First of all, a distinction is made between “hypertrophic” scars and “atrophic” scars. Unlike the sunken ("atrophic") scars, hypertrophic scars are red and raised. If there is excessive scarring, i.e. if the original area of ​​the injury is exceeded, doctors speak of a keloid. This is a benign but stubborn tumor that seldom resolves on its own.

Hypertrophic scars, on the other hand, can disappear on their own after months, but can also cause discomfort over a long period of time. "Even if hypertrophic scars and keloids are benign skin changes, many of those affected require treatment because the symptoms can severely impair their quality of life and lead to their stigmatization," says Paasch.

Cortisone and icing are combined

According to the guideline, the most important treatment options for hypertrophic scars and keloids are the injection of triamcinolone in crystal suspension and cryotherapy. ”The synthetic glucocorticoid (cortisone) triamcinolone is injected directly into the scar. It reduces excessive scar growth by inhibiting collagen synthesis. Cryotherapy involves freezing the scar with liquid nitrogen. The updated guideline recommends using both in combination.

Burn scars respond well to laser therapy and microneedling

If a hypertrophic scar has arisen after a burn or scalding and causes problems, the guideline recommends three treatment options at the same time: Fractional ablative laser therapy, microneedling and compression therapy have proven successful. In fractional laser therapy, a wound healing sequence is initiated in which heat shock proteins play a decisive role. Microneedling means that the skin is pierced with many small needles, which leads to so-called microtraumas. These trigger a wound healing cascade, which, like laser therapy, leads to "remodeling" in the skin.

Beware of the scalpel

The therapy options hyaluronidase, calcium channel blockers and plasma are mentioned for the first time in the guideline. However, due to the limited amount of data available for these treatment options, the experts cannot make any recommendations for or against their use.

Because of the low chances of success, surgical measures are only recommended after careful consideration and with additional follow-up treatment such as radiation, pressure treatment and triamcinolone injection.

"It should be noted that the treatment of hypertrophic scars must always be a therapy that is individually tailored to the patient," emphasizes DDG media officer Professor Peter Elsner from Jena University Hospital. Often enough effectiveness is not achieved with just one therapeutic approach. "A combination of several therapies is necessary," says Elsner

Photo: © Adobe Stock / Goffkein

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