What is the best way to prevent scars?

Best Methods for Preventing Scars

The most effective approach to prevent scarring is to apply silicone gel sheeting or silicone gel immediately after wound epithelialization, combined with proper wound care techniques. 1, 2

Understanding Scar Formation

Scarring occurs as part of the natural wound healing process, but excessive scarring can lead to:

• Hypertrophic scars (raised but confined to wound boundaries)
• Keloids (extending beyond original wound margins)
• Cosmetic and functional impairment

Prevention Strategy Algorithm

1. Immediate Wound Care

• Gently cleanse wounds with warmed sterile water, saline, or diluted chlorhexidine (1/5000) 3
• Apply greasy emollients (50% white soft paraffin with 50% liquid paraffin) over the epidermis 3
• For blisters: decompress by piercing and expressing fluid rather than removing the roof 3
• Apply non-adherent dressings to denuded dermis (e.g., Mepitel™ or Telfa™) 3

2. Post-Epithelialization Care (Once Wound Has Closed)

• Primary Prevention: Apply silicone gel sheeting or silicone gel 1, 2, 4

  • Start immediately after epithelialization
  • Apply for 12-24 hours daily
  • Continue for at least 2-3 months
  • Mechanism: Creates optimal hydration environment and reduces fibroblast activity

• For high-risk areas or individuals prone to keloids:

  • Consider intralesional triamcinolone acetonide (TAC) injections (10-40 mg/mL) every 3-4 weeks 5
  • Avoid ear piercing or other body modifications if history of keloids exists 5

3. For Surgical Wounds

• Consider applying silicone sheeting immediately after surgery rather than waiting for complete epithelialization 6
• For planned surgeries in high-risk individuals, discuss preventative measures before the procedure 5

4. For Facial or Delicate Areas

• Use milder treatments to avoid causing additional damage
• For plane warts or lesions on face: use lower concentration salicylic acid (2-10%) or milder cryotherapy to prevent scarring 3
• Avoid cryotherapy on earlobe areas due to risk of tissue damage 5

Special Considerations

For Larger or At-Risk Wounds

• Consider combination therapy for wounds at high risk of scarring:
  • Silicone products plus pressure therapy
  • Silicone plus intralesional steroids for higher-risk areas 5
  • For extensive wounds, consider consultation with burn or wound specialists 3

For Inflammatory Skin Conditions

• Treat underlying skin inflammation promptly
• For severe cutaneous adverse reactions like Stevens-Johnson syndrome/toxic epidermal necrolysis:
  • Proper fluid management and wound care are critical 3
  • Consider transfer to burn center for extensive epidermal loss 3

Monitoring and Follow-up

• Assess scars regularly using validated scales (e.g., Modified Vancouver Scar Scale) 4
• Continue preventive measures for at least 2-3 months, as scar maturation can take 6-12 months
• If signs of abnormal scarring develop despite prevention, intensify treatment early

Common Pitfalls to Avoid

1. Delayed intervention: Starting scar prevention too late after wound healing
2. Inadequate duration: Stopping silicone therapy too early (continue for at least 2-3 months)
3. Inappropriate expectations: Not counseling patients about realistic outcomes and potential need for multiple treatment modalities 5
4. Overlooking high-risk individuals: Not identifying patients prone to keloid formation before procedures
5. Aggressive treatments: Using harsh treatments that may cause additional trauma and worsen scarring

Silicone gel products have demonstrated superior efficacy in preventing hypertrophic and keloid scars compared to no treatment (RR 0.70; 95% CI, 0.49-0.99) 2, though the quality of evidence has limitations. When compared with tretinoin cream, both treatments showed similar effectiveness in preventing abnormal scarring 4.