Scar Management

As presented at the 2015 American Academy of Dermatology meeting in NYC by Dr. Hughes, following surgical excision of skin cancers, cosmetically unsatisfactory scars can be improved. The method is dependent on the nature of the scar.

“Grooved” scars are resurfaced (ablated) at 4 to 6 weeks post-op (Don’t wait!). This may be accomplished with the Erbium:Yag laser, dermabrasion, or chemabrasion with trichloroacetic acid.

Red hypertrophic scars are treated with the 595nm pulsed dye laser, intralesional steroids and 5-FU, topical steroids or topical tacrolimus ointment. Treat “the sooner the better.”

Stretch marks are scars. Red stretch marks are the easiest to treat (595nm pulsed dye laser and topical retinoids).Old white stretch marks are improved with the long pulsed Nd:YAG laser and topical retinoids.
“Trapdoor” deformities may be managed with intralesional steroids.

Acne scars are improved with Er:YAG laser resurfacing (boxcar scars), dermal fillers (gouged scars), TCA chemosurgery (gouged scars), long pulsed Nd:YAG laser (gouged or pitted scars), or excision (deep pitted scars) with resurfacing.

In worst case scenarios, the scar can be re-excised and then resurfaced at 4-6 weeks. Keloids can be excised and the area treated with topical Aldara post-op to prevent recurrence.

I tell my skin cancer patients, “First we want to cure the cancer, but second, we want a nice cosmetic result. If we are ever unhappy with a scar, it can be improved.”

Philip Hughes, M.D.

Course Director and major speaker on “Scar Management” at 2015 American Academy of Dermatology annual meeting in NYC.

Before After

Trapdoor deformity: intralesional injection Rx