Scar management

Historic scars

For long-term scars, Lucy says there are additional services which are available to customers: "Some of which may be offered in pharmacy and some which may need referral to other providers – such as microneedling, laser therapy or, in some cases, dermal fillers."

Ioannis says soft tissue manipulation techniques can also be "invaluable" in improving scar tissue characterised by lack of pliability/softness, but Dr Aslam stresses that managing customers’ expectations is vital here: "Pharmacy teams should support customers to be realistic that most scars are permanent, and no OTC product will help if the scar has been there a long time," she says.

Scar camouflage

If the scar can’t be treated, people may choose to buy specific skin camouflage products to cover it or see a qualified camouflage therapist. "Products that are designed to cover scars can be especially useful for customers with facial scarring and, in certain circumstances, can be available upon prescription", says Lucy. 

Customers with a large area of skin to cover who live in England or Scotland can access the Skin Camouflage Service run by the charity Changing Faces (changingfaces.org.uk/services-support/skin-camouflage-service), either via a GP or through self-referral. Their fully trained skin camouflage practitioners will help find a good colour match for the person’s skin tone and teach them how to apply the make-up. The products are long-lasting, waterproof and suitable for the face or body, and can stay in place for two or three days.

Scars can also affect different skin types in different ways. "For example," says GP Dr Nisa Aslam, from Typharm’s Skin Life Sciences Foundation, "darker skins can get darker keloid areas, and as smoking thins the skin and affects the blood supply to the affected area, smokers can end up with poorly healed scars."

Dr Aslam prescribes camouflage - makeup and has seen how important it can be. "Some patients find it really difficult to live with their scars", she says, "and I know that camouflage - makeup can make an emotional and mental health difference to people. It’s important to remember how emotionally upsetting any kind of perceived disfigurement can be – driving many people to be suicidal – so we have to take this seriously, and community pharmacy teams are in the ideal place to help."

OTC scar management

Many scars will gradually fade over time, especially when managed with the support of over-the-counter (OTC) products available at community pharmacies. One simple OTC product that may help is an appropriate skin cream. 

"Although there is no strict medical evidence of effectiveness, Vitamin E cream is often recommended for managing scars, as the act of massaging a moisturiser into a scar can help the skin remain supple and ease tension," says Lucy Morris, Numark patient services manager. "And as scars can be more sensitive to sun, it is important to protect scar tissue from any extra damage with a sun screen."

Ioannis Goutos, plastic surgeon and BSF spokesperson, says another evidence-based approach for linear scars is the application of paper microporous tape. "This has a variety of different actions including the provision of external support to the fresh scar as well as preventing water loss and contributing to a better moisturisation status", he says, with patients "encouraged to apply a strip of paper microporous tape to the scar for a period of eight to 12 weeks following a wound healing."

As with so many conditions, Dr Aslam says prevention is better than cure. "By improving your overall health, you can optimise scar healing", she says, "so pharmacy teams have a role to play in educating customers about the importance of having good nutrition including all the necessary vitamins and minerals, as well as proteins since amino acids are the building blocks to heal the skin."

Act fast

Ioannis says prompt and appropriate wound care/scar management is also key in order to ensure optimal long-term scar quality. "There is emerging evidence in the scar literature that intervening at the earlier stages with minimally invasive techniques – such as lasers – can have a beneficial effect in scar remodelling," he says.

However, with laser therapy not available to everyone, Dr Aslam’s recommendation is at least to act fast. "It’s easier to lessen scars during the wound healing stage than afterwards", she says, "so customers should do what they can, as soon as they can, using the appropriate OTC products such as emollients alongside good nutrition including boosting vitamin C and E, with a referral to their GP to start medical treatment if needed".

C-section scars and stretchmarks

Nisa says problems related to C-section scars are one of the most common scarring issues she sees as a GP but adds: "C-section scars can get good results from early treatment, and a key point to educate customers on is also spotting signs of infection. If the wound is red, hot, or weeping, refer your customers to see their midwife or doctor for antibiotics to treat any infection and prevent the scar from worsening."

Acting quickly can also prevent or lessen stretch marks, according to advice from pharmacist Deborah Evans, managing director and owner at Pharmacy Complete and Remedi Health, and a spokesperson for Bio-Oil. 

"Stretch marks are more likely to occur during rapid growth, weight gain or during pregnancy", says Deborah, "and itching can often be the first sign. To help prevent stretch marks in pregnancy, massage a moisturiser or an oil in daily to improve skin elasticity and help it to stretch. New stretch marks will fade from red/purple to fine silvery lines that are harder to see but massaging a cream or oil into the skin can help this process."