Why are acne scars raised?
A lump may remain on the skin after acne, or it may be raised with redness. Most are convexities called hypertrophic scars, but in rare cases they may be keloids, milium or epidermoid cyst.
What are hypertrophic scars and keloids?
Hypertrophic scars and keloids are distinguished as separate conditions, but both are excessive accumulations of collagen fibres and are difficult to distinguish histologically.
Both conditions are caused by abnormal or delayed wound healing processes, resulting in the overproduction and elevation of scar tissue.
Hypertrophic scars may gradually flatten over several years and the redness may disappear to become a normal scar, but they often remain as ‘lumps’. Keloids do not tend to heal, but form as a seepage into healthy areas. They are highly resistant to treatment and have a strong tendency to recur. Hypertrophic scars and keloids may coexist in one scar.
Treatment for hypertrophic scars and keloids
A combination of several methods is used depending on the symptoms. The treatment period takes 1~4 years, depending on the medical condition.
The most important step in healing hypertrophic scars and keloids is to avoid tension (stretching force) on the skin. For this reason, the silicone gel sheet called ATOFINE, described next, is the cornerstone of the treatment.
1. Atofine (scar care tape)
| How to use | Apply once every 5-7 days to a larger area than the affected area. Keep the tape on as long as it does not peel off. |
| Characteristics | Atofine is made of silicone gel and has no medicinal properties. Applied around the affected area, it prevents tension from being placed on the skin and prevents the growth of hypertrophic scars and keloids. |
| Side effects | Tape rash has been reported. No serious side effects. |
1. Tranilast (oral medicine)
| Dosage | Take one tablet three times a day, after each meal. |
| Characteristics | Prevents hypertrophic scars and keloids from worsening by inhibiting fibroblast collagen production. Anti-allergic action reduces itching of the lesion. |
| Side effects | Rash and itching may occur. Gastrointestinal symptoms such as abdominal pain, nausea and vomiting, psychiatric symptoms such as headache, dizziness, insomnia and fatigue, as well as irregular periods, palpitations, oedema, fever, stomatitis, anaemia, hair loss, liver dysfunction, renal dysfunction, cystitis-like symptoms such as frequent urination and pain during urination, and decreased blood cell composition have also been reported. Serious side effects are very rare. |
2. Steroid Ointment
| How to use | Apply to the affected area twice daily. |
| Characteristics | Steroid ointment. Used to improve and prevent hypertrophic scars and keloids and to reduce itching. |
| Side effects | Dermatitis, rashes, skin atrophy, acne, folliculitis, vasodilatation, rosacea-like dermatitis, hypertrichosis, vitiligo and skin infections may occur. Glaucoma and cataracts have been reported with long-term use around the eyes. |
3. Steroid Tape (Eclar plaster)
| How to use | Cut a piece of tape to the appropriate size for the lesion and apply it once a day for 24 hours, avoiding contact with healthy areas as much as possible; if it is difficult to apply it for 24 hours, apply it for 12 hours. If irritation from the paste change causes a rash, you may continue to apply the paste for two days. |
| Characteristics | Steroid tape. Gradually flattens hypertrophic scars and keloid elevations. |
| Side effects | Dermatitis, rashes, skin atrophy, acne, folliculitis, vasodilatation, rosacea-like dermatitis, hypertrichosis, vitiligo and skin infections may occur. Glaucoma and cataracts have been reported with long-term use around the eyes. |
4. Kenacort Injection
| Treatment method | A small amount of a mixture of Kenacort and anaesthetic is injected into the lesion. If the injection is painful, anaesthetic tape and cooling agents are used in combination with the treatment. Initially, the injection is very painful, but after a number of times it becomes less painful. |
| Treatment frequency | Multiple injections are given at intervals of at least 4 weeks. Depending on the symptoms, the patient may switch to other treatments such as tape during the course of the treatment. |
| Characteristics | Strong steroid injections. Softens hard keloids and hypertrophic scars and flattens raised areas. |
| Those who are not eligible for treatment | Peptic ulcer, mental illness, tuberculosis, herpes simplex keratitis, cataract, glaucoma, hypertension, diabetes, history of thrombosis, liver dysfunction, hepatitis, renal dysfunction, recent major surgery, osteoporosis, hypothyroidism, scleroderma. |
| Side effects | There is a risk that the lesion may become too indented after multiple injections. Menstrual irregularities, acne, folliculitis, rashes, skin atrophy, vasodilation, rosacea-like dermatitis, hypertrichosis, vitiligo and skin infections may occur. Serious side effects reported include infection, adrenal insufficiency, diabetes, peptic ulcer, pancreatitis, psychomimetic changes, depression, seizures, osteoporosis, aseptic necrosis of bone heads, myopathy, cataracts, glaucoma, thrombosis, anaphylactic shock, asthma attacks, visual impairment and tendon rupture. The maximum total injection dose at our clinic is 5 mg, usually less than 1 mg per site for a defined period of time, so serious side effects are very rare. |
5. Laser Treatment (Kojimachi office only)
In cases of hypertrophic scars and keloids with redness and dilated blood vessels due to side effects from steroids, vascular treatment laser therapy is used in parallel with other treatments. The laser destroys and reduces the size of the microvessels and improves their coloration; irradiation is carried out at 3-4 week intervals and the treatment is carried out for 1~2 years.
6 Other Treatments (Not done in our clinic)
Other treatments not mentioned above include compression therapy with silicone gel sheets, cryotherapy with liquid nitrogen (cryotherapy), radiotherapy (electron beam radiation) and surgery (Z-plasty).
Fees (Tax included)
The hypertrophic scar and keloid treatment we provide is at your own expense, so please consult your local insurance dermatologist first.
| Consultation fee | First visit ¥3,850 Repeat visit (Not required for treatment only) ¥1,650 |
| Atofine (scar care tape) | 1 box \1,980 |
| Tranilast (oral medicine) | 1 tablet \22 |
| Eclar plaster (steroid tape) | 1 kit \220 |
| Kenacort Injection (steroid injection) | \3,190~ |
| Laser Treatment | ~2cm2 (per part) \5,500 2~5cm2 (per part) \9,900 5~10cm2 (per part) \19,800 |
| Anesthesia | Local anaesthetic injection ¥330 Lidocaine dressing (1 kit) ¥330 Anaesthetic cream (per face area) ¥3,300 Anaesthetic cream (5 x 5cm) ¥1,650 *Prices vary depending on the size of the area covered |
