Surgical Dermatology

[drmithila]

A number of Oral & Maxillofacial Surgery departments 

carry out Surgical Dermatology.

This might seem odd at first glance, but the clinicians often
have had first-hand experience of suturing up (sewing up)
faces.  Often, if one of the consultants in OMFS Department
has an interest in Surgical Oncology, there is a concomitant
interest in Surgical Dermatology.

Hence, in an OMFS Department you may have skin lesions
removed / biopsied or have scars revised.  Consequently,
advice can be given regarding the care for scars, diagnoses
of skin lesions etc.

        

[drmithila]

 What are scars?

Scars are produced as part of the body’s normal healing 

process.

No matter how careful or meticulous the repair after an 

accident or operation, there is always a permanent and 

visible mark.

The quality of the scar varies from one individual to another 

and from one part of the body to another.  It is impossible to 

be sure how a scar will eventually look.  The scar may be 

very stretched or may at first be irregular and become 

smoother with the passage of time.

The scar may become redder, harder and more raised (up to 

4 months post-injury) but will hopefully settle over a period of 

12 – 18 months, when it becomes more supple, flat and pale 

(it has ‘matured’).

Looking after your scar

Massage can help to heal scars.  It reduces the tendency for 

the skin to stick to any underlying structures and is thought to 

speed up the healing process, reducing the redness and 

irregularity.

Massage should involve moving the scar on the underlying 

structures rather than rubbing the surface of the scar itself.  

For best results this should be repeated for 5-10 minutes, 

several times a day, perhaps after washing and bathing.  

Lanolin, Vitamin E oil or a neutral moisturiser can help to 

lubricate the wound during the massage.

You will need to wait until the scar is strong enough before 

you begin massaging.  It is wise to ask the doctor or nurse 

after the stitches are removed when the best time to start 

massaging the scar is.

Protecting your scar from sunlight

Scars are more prone than normal skin to injury from sunlight.

It is best to avoid exposing a scar to strong, direct sunlight 

for the first 12 – 18 months following injury.  A sun-block 

cream with a high SPF (Sun Protection Factor > 30) and a 

wide-brimmed hat for scars on the face will help if you 

cannot avoid going out in the sun.

If scars are allowed to tan, they may fade to leave a mottled, 

patchy appearance.  Scars often itch in the heat so staying 

out of direct sunlight may increase comfort.

Treatment For New Scars

Steroids

Giving steroids by injection is one of the oldest and most-

established approaches to treating scars.

The drawbacks of this treatment are the number of side 

effects brought about by repeated injections (pain; infection; 

localised skin death; dilated superficial blood vessels and 

the depressing of the scar) and the frequent occurrence of 

de-pigmentation (white patches on the skin).

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)

Although NSAIDS have been used to prevent internal scarring 

in arthritis for many years, they have only recently been used 

for treating hypertrophic and keloid scars.

Research has found that salicylate compounds (as used in 

acne) applied directly is very effective on new scars.  Using 

salicylate this way should be done under a doctor’s guidance 

since some patients, particularly asthmatics, may develop 

sensitivity to the drug.

Anti-Histamines

These are commonly used to control the itching caused by 

new scars but they do have other anti-scar properties.

Anti-histamines subdue the inflammatory response resulting 

in a smaller and more comfortable scar.  Patients taking anti-

histamines are less likely to scratch their scars which 

reduces the scar growth rate and high-dose anti-histamines 

can slow down the production of collagen in the skin (which 

is responsible for scar formation).

Elastic Wraps

Elastic support and clothing are commonly used in scar 

prevention.  The drawbacks are that they retain heat and 

restrict movement.

Gel dressing

Sheets of hydrogel and silicone dressings are sometimes 

used to prevent excessive scarring.  They increase the 

moisture in the skin over the scar and affect the scar 

temperature.

They can be used in conjunction with anti-inflammatory 

creams and ointments to lessen scarring, and are available 

in some chemists.

Treatment for Old Scars

Mechanical tension blockers

Several drugs commonly used to treat high blood pressure 

can be used to cause the breakdown of older ‘settled’ scars.  

‘Calcium channel blockers’ injected into the scar can 

encourage the scar to break down.

Surgical Removal / Scar Revision

Surgical removal is usually only used for big scars that are 

unlikely to fade using any of the methods listed above over a 

reasonable time period.  Surgery can also help scars that 

harbour infection and scars that hamper movement.

This kind of precise surgery has to be supported by 

additional measures to reduce swelling, ease skin tension 

and other factors in order that further scarring doesn’t occur.

Use of lasers and other burning methods

Laser use and other burning techniques have been used for 

scar removal but as yet there is not enough evidence to 

support them as a reliable method for treatment and their 

use is still considered controversial.

        

[Drsumitra]

What is Intra-Lesional Steroid Therapy?

Intra-lesional corticosteroid therapy is a procedure where a
steroid solution is injected into the scar with the aim to
improve the appearance and decrease the size of the scar.

The steroid most commonly used is called triamcinolone.

This works by increasing the activity of an enzyme called
collagenase. This enzyme breaks down collagen in the scar
so that the scar becomes less thick and red.

The steroid does not change the amount of collagen made
by the cells nor does it decrease the number of cells making
collagen; its action is primarily to remove some of the
excess collagen from the scar.

This technique is commonly used in dermatology and plastic
surgery, either alone or in combination with other forms of
treatment, to treat a number of skin conditions.

Often multiple small injections are carried out and you will
need more than one session of treatment.

Side Effects of the Treatment

There are a few side effects which you may experience;
these tend to improve with time, your clinician may halt
treatment if these cause any concern.

Common Side Effects

Pain: the procedure is generally well tolerated but injections
into certain areas of the body, for example, palms of hands
or soles of feet can be more sore.

Bleeding: small amounts of spotting with blood can occur
after the injection.

Occasional Side Effects

Atrophy: shrinkage of the tissue at and around the sites of
injection may occur. This results in a white depressed area,
or small scar like areas. The face, genitalia and lips are
more susceptible to this than other parts of the body.

Hyper / Hypo-Pigmentation: changes in pigmentation can
occur at and around the sites of injection with either
lightening or darkening of skin colour.

Telangiectasia: infrequently, tiny dilated blood vessels or
small red spots called purpura may become visible at the
injection site.

Rare Side Effects

As the total dose of steroid being injected into the skin is
small, the risk of the steroids being absorbed into the blood
stream and producing generalised or systemic side effects
are extremely small.

        

[Drsumitra]

What is a Seborrhœic Keratosis? Seborrhœic Keratoses (SK’s) are also known as seborrhœic  warts, senile warts and basal cell papillomas. SK’s are caused by a build up of ordinary skin cells on the  top layer of the skin.  The reason for this is not known.

Photographs of Seborrhœic Keratoses

A familial predisposition is apparent.  SK’s may also be a consequence of inflammatory skin conditions ormalignancies.   SK’s are not caused by a virus. What are the signs and symptoms? SK is a common benign growth occurring in older persons. It is typically a solid raised discrete lesion of 5 mm or less (a  papule) of variable colour from light brown to almost black. SK’s may be smooth or wart-like with visible pitting. Common sites include the face, trunk, and extremities. The  lesion also may be stalked or non-stalked (that is, directly  adherent to the skin).  SK’s can itch. They are not infectious and do not become malignant. How is it treated? Many patients require no treatment. Simple surgical excision, scraping or freezing are the  principal modes of removing SK’s.  SK‘s generally are  removed if they are catching on clothing, itch or look unsightly.

 

        

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