Thank you for contacting Health at Hand.
To have an itchy scar on your back must be very awkward. Often scars like this can cause anxiety and disrupt sleep, so we can understand it must be causing you considerable discomfort.
The best treatment is to wash the skin with a moisturising shower gel or a bath additive. This will prevent the skin becoming dry. Then apply and massage a fragrance free moisturizer cream or ointment to clean dry skin. You will need to do this on a daily basis for several months and even longer. Silicone based gels and sheets can be particularly effective for stubborn deep scars.
As the scar is healing it is important to protect it from sunlight to prevent it becoming dark and prominent. It is a good idea to keep it covered for a year or more. Alternatively use a suntan lotion or cream or sun block of SPF 35 or greater if your back is going to be exposed to the sun.
An itchy, hot painful scar can be a sign of infection which will need the attention from a doctor or a prescribing nurse. If the scar is just itchy taking antihistamine tablets can help to stop the itching. This will in turn stop the itch scratch cycle so help prevent infection.
We have included the information below because we thought it may help you to understand the nature of scars and how best to care for them.
What happens when you have a cut of wound for example after surgery?
When you have a cut in the skin the body repairs itself. Immediately after a break in the skin a scab is formed so closing the gap and preventing infection. This layer is not very strong.
Once the scab is formed wound will heal from inner layers and progresses to the upper layers of the skin. A cut or a wound heals in 3 phases.
- Initial inflammatory phase. This is natural response and the first phase where the blood vessels contract to form a clot. Once the bleeding has stopped the blood vessels dilate to allow white blood cells, antibodies and other essential nutrients into the area.
- The proliferation phase. During this phase the granular tissue which includes collagen builds up to form new skin. Healthy granulation tissue is dependent on a number of factors including a good source of oxygen and nutrients. It often looks uneven and is pink in colour and less likely to bleed. The appearance of the wound at this stage gives an idea of whether the wound is healing well or if it is infected.
- The maturation phase or the remodelling phase is the final stage of repair.
During this stage the scar flattens and becomes softer as some of the collagen disappears. This stage can last anywhere between 12-18months or even longer in some cases.
- It is important to remember that the healing process of the wound or a cut is changing all the time between these phases. It can go back and forth through the second and the third phase. Ideally the wound should heal from the deeper layers to the upper layers so this can take time. If the wound heals from the top layer the deeper layers can still be raw and the wound will then break open again. This is why care, time and ideal conditions are needed to allow the wound to heal.
What is a scar?
A scar is a raised thick skin that leaves a permanent mark after a wound is healed. Scarring is a natural part of tissue repair where the wound appears red at first then as time progresses to regain the appearance of normal skin. This process can take up to two years providing the scar is regularly massaged and moisturised.
However, some scars don’t heal well and can grow over normal skin so cause problems. There are two main types of scars that are difficult to heal namely:-
- Hypertrophic scar or
- Keloid scar
A hypertrophic scar is formed generally when the deeper layer of the skin call the dermis is damaged. It forms when the body makes excess amount of collagen during the repair process.
- It tends to be red, raised, and thick in appearance and can be itchy.
- It appears three weeks after an injury or surgery and settles naturally after 1-2years.
- This type of scar usually does not spread outside the original injured area.
A keloid scar on the other hand tends to spread outside the original injured or wound boundary.
- It develops 3-12months after the original injury or excision from surgery.
- It can stay elevated and is very difficult to disappear. A keloid scar is usually shiny, hairless, elevated above the skin, hard and rubbery, red or purple at first then tends to become pale or dark.
- It is usually painless but can become tender, itchy and painful.
You mention that you had the surgery a couple of months ago. This means that the scar is still fresh so it is difficult to determine at this stage what type of scar this is.
Medications to help to reduce scars
Keeping the skin moisturised once the initial wound has healed, after approximately 3 weeks, is the best method of preventing or reducing scars. Bath emollients and moisturising the skin will help to return the skin.
Emollients are preparations that soften the skin. Sometimes the skin can become too dry whilst it is healing, so the skin can become puckered. Using soap and water to cleanse the skin can cause the skin to become dry and irritated.
Emollients can help to prevent this effect and may help to calm the scar. Adding bath oil or additive or using an emollient shower gel can help to soothe, hydrate and make the skin smooth However; the effects are short lived so a moisturising cream or ointment needs to be applied on the area to provide longer term benefit.
Examples of suitable emollients include
Aveeno bath oil
Balneum bath oil
Doublebase emollient bath additive or shower gel,
E45 bath oil or E45 wash cream,
Oilatum emollient bath additive or shower gel
QV bath oil and QV gentle wash or
Moisturisers allow the skin to retain moisture for a longer time than the bath additives and shower gel and should be used after the skin is washed and dried thoroughly. The following examples are suitable to use for small scars. Sun block cream with SPF 35 or greater may be suitable for skin that is exposed to sunlight.
- Aveeno cream
- Diprobase cream or ointment
- Doublebase cream or ointment
- Epaderm ointment
- E45 cream
- Hydromol ointment
- Oilatum cream
The difference between creams and ointments is that the ointments tend to be oil based and stay on the skin longer but can have an oily feel. Creams on the other hand are water based and tend to rub well into the skin so easier to apply but do not stay as long as the ointment.
Silicone gel products:
For deeper scars, hypertrophic and keloid scars silicone based products have proved to be more effective. They help to reduce scar elevation and pigmentation so prevent the scar becoming darker.
You would need to apply a small amount of the silicone based gel and massage it into the scar with your fingers in a circular motion. Massaging the wound for about 10 minutes two or three times a day Every day for several months after surgery will help to clear the scar tissue.
The silicone gels on the market include
- Kelo-Cote UV
- Kelo-Cote gel,
- Kelo-cote spray
- Silgel STC-SE.
Why massage the scar? Is it really necessary?
As mentioned above the wound healing process is changing all the time. About three weeks after surgery the wound can tolerate pressure. Massaging the scar using gentle pressure allows the wound to heal in such a way that the restored skin is soft and supple and has the normal range of movement and elasticity.
Silicone based sheets
Using silicone sheets may be another option. These sheets can be applied to the scar
once a day for 12-23hours. They are very easy and convenient to apply.
The Silicone sheets on the market include;
- Advasil Conform,
- Bapscarcare T,
- Scar FX and Silgel.
We suggest that you can take an antihistamine tablet or capsule if you do not have any accompanying pain and the wound is not hot or throbbing.
As we mentioned earlier taking antihistamine tablets can help to stop the itching. This will in turn stop the itch scratch cycle so help prevent infection.
There are various antihistamine tablets on the market that you can buy from the pharmacy or even from a supermarket or a drug store.
Chlorphenamine 2mg tablets more commonly known by the brand Piriton.
- You can take up to three tablets in a 24hour day.
- It can make you drowsy so you cannot drive or operate machinery all the time you are taking this tablet
Cetirizine, Loratadine and Acrivastine are all non-drowsy antihistamine tablets
Cetirizine and Loratadine.
- The dose of Cetirizine and Loratadine are one tablet once a day.
- If the symptoms return you cannot take another tablet until 24hours after the previous dose.
- It can be taken up to three times a day so if symptoms return another tablet can be taken 8hours after the first tablet.
- It works in 15minutes
- It is more expensive than the other antihistamines available over the counter
- It cannot be sold to anyone of 65years old because of lack of evidence based data
We suggest that if your GP has not examined the scar recently then it would be good idea to see him/her before using any of the products listed above so that you can rule out any accompanying infection or eczema.
Your GP may prescribe a steroid cream if he/she thinks it is necessary.
You can see further information in the web links below.
Hypertrophic scars - Dermatix
Keloid Scarring - NHS
Scar Management - NBT
Managing your scar - Moffitt
Please do not hesitate to contact Health at Hand if you need further information.