Normotrophic scars are usually formed after injuries (as well as self-injuries, eg in the form of cuts), surgery and need treatment during the maturation period. Normotrophic scars mature within 6-9 months and, if ignored, can turn to hypertrophic, keloids or atrophic scars (Fig. 1). Therefore, normotrophic scars should be under the supervision of a specialist during the maturation period.
Treatment of normotrophic scars with microdermabrasion
Microdermabrasion of normotrophic scars – skin polishing of the scar localization with aluminum oxide microcrystals (Al2O3). Aluminum sand is applied onto the skin surface by means of negative pressure and, knocking the particles out of the problem zone, aluminum sand is sucked into another container. Vacuum enables to elevate the scar bottom (Fig.2). This method does not require anesthesia, the recovery period being 4-10 days. Patients retain social activity. In some countries this method is called “A weekend procedure”. To achieve tangible results, 3-5 procedures are required with a 3-4 week interval.
Microneedling for normotrophic scars treatment
Microneedling or Collagen Induction Therapy (CIT) is performed using application of dermaroller (Fig.3) or dermapen. Microneedles of dermaroller or dermapen penetrate into the skin and form hundreds of microscopic channels. Following a number of complicated consecutive reactions (hemostasis – inflammation – proliferation – remodeling), fibroblasts (special skin cells) “patch” the microscopic channels formed by dermaroller or dermapen needles. Collagen islands are synthesized within the channels, which are attracted to one another, thus gradually aligning the edges of scars.
In this manner an elastic backing of fresh collagen tissue is created on the one hand, decreasing the width of scars by retracting and elevating their bottom to the skin surface on the other hand. Transformation of atrophic scars to normotrophic shows that fresh atrophic scars can be remodeling to normotrophic scars with the microneedling (Fig.4)
Topical treatment of scars. Scar removal creams
Different ointments, creams and gels are applied depending on the stage of scar formation, such being antibacterial, normalizing blood circulation, reducing or stimulating collagen synthesis, diluting wound environment, boosting immunity of the wound area, etc. To this end are using such of the scar removal creams: Kelo-cote, Dermatix, Strataderm, MedGel, Kelofibrase, Scarguard, Contractubex, Aldara. Each individual case surely requires a consultation with the attending physician to select the necessary cream or ointment, because some products are capable of not only improving, but as well as of worsening the scar condition. Topical treatment of scars is usually applied either in parallel to or after mechanical treatment methods.
Hydration of scars
Hydration of scars helps to cells freely migrate and share the necessary information among each other. In the recent past potassium permanganate solution (KMnO4) was commonly applied onto a fresh wound. An crusts subsequently developed under which a scar was starting to form. Nowadays there is no doubt that a rough scar is formed under the crusts. A wound should be healed in humid environment. A number of application products are used for wound hydration, capable of retaining liquid within the area of scar formation.
Reduction of scars with chemical peels
Glycolic acid peels with 50-70% AHA are usually made after a month-long preparation. Prior to the AHA exfoliation treatment, a cream containing tretinoic or glycolic acid is applied within one month. But still, the result is unsatisfactory. TCA peels (trichloroacetic acid) penetrate deeper than AHA, so it gives better results (Fig. 6).