NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 2 Scar Management Exceptional healthcare, personally delivered NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 2 Scar management service Managing scars can involve using creaming and massage silicone gels and/or pressure garments to prevent or reduce hypertrophic scarring (these are scars that are red, raised, hard, sometimes sensitive and often itchy), that may occur following a burn injury, skin grafting, surgery or a laceration. Scarring may take around 2 years to mature so treatment can continue this long. Scars cannot be removed but these treatments can reduce itch and pain and leave scars soft, flat, supple and pale. Creaming and massage Scars and skin graft donor sites require regular creaming to prevent the area from drying, cracking and becoming sore. This is because newly healed skin is unable to lubricate itself in the same way as undamaged skin. Initially, creams must be applied gently but this should gradually progress to massage. 2 ■ Creaming should be carried out 2-3 times a day for at least 5 minutes, using aqueous cream or a non-perfumed moisturiser (e.g. Nivea, E45 etc.) ■ It is also very important that your skin is fully cleansed each day as the build up of cream can cause skin irritation. ■ Massage involves firm pressure in circular strokes over the scars, paying particular attention to any hardened or raised areas. This process may initially be uncomfortable as your scars can be quite sensitive but with perseverance this will quickly progress to feeling comfortable and soothing. Scar Management NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 3 Sun protection It is very important that scars and donor sites are protected from the sun. Complete sunblock is recommended for at least 2 years. Once the scars have matured we still recommend your skin is protected from the sun with at least SPF15 suncream. Silicone therapy These are either in the form of adherent dressings or creams that are most commonly used on small, stubborn scars or areas difficult to apply pressure (eg. faces). You will need to be reviewed regularly to check the appropriateness and effectiveness of your treatment. There are many different forms of silicone gel on the market, examples of which include: ■ Cica Care gel ■ Mepiform ■ Silgel ■ Dermatix ■ Kelocote Silontex ■ Scarsil ■ Your gel will have been specifically chosen for you by your therapist as the most appropriate product to manage your scarring. (You may be able to get your silicone gel on prescription from your GP.) Silicone Gel Sheet Type 1 e.g. Cica Care / Dermatrix ■ Your gel should be cut to size to cover the scar. Your gel is self-adhesive but may require further fixation with a bandage or tape. ■ You should wash your gel twice daily in mild non-oily soap, rinse in warm water, allow to dry, then re-apply. At the same time cleanse and dry your skin as normal. Moisturising cream should still be used but needs to be fully absorbed before re-applying your gel. ■ Your gel should be worn for at least 12 hours a day and where possible worn 23 hours a day. Scar Management 3 NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 4 ■ You will need to build up your wearing time slowly (see wearing schedule) to prevent your skin reacting to the gel. ■ When your gel begins to deteriorate and cleaning becomes difficult your gel should be replaced (one piece will last between 1-2 months). Silicone Creams e.g. Silgel/Kelacote ■ Silicone cream should be applied to your scar twice a day. Morning and evening are usually the best times for this. ■ Before being applied/re-applied, your scar should be fully cleaned as normal. ■ Continue to apply moisturising cream but allow this to fully absorb before applying the silicone cream. Silicone Gel Sheet Type 2 e.g. Mepiform 4 ■ Cut your gel to the appropriate size. Make sure the area is dry and your moisturising cream is fully absorbed then apply. ■ Ideally your gel is worn for 24 hours a day but can be effective with a 12 hour wearing time. ■ Remove your gel once or twice a day to wash, cream and check your skin. ■ Initially, the wearing time should be built up slowly (see wearing schedule). If a rash occurs remove the silicone, allow the skin to settle, then start to re-build your wearing time. ■ One piece of silicone will last between 3–7 days. It then loses its adhesive properties and needs replacing. ■ Silicone is waterproof but is probably best removed for bathing or swimming. Scar Management NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 5 Precautions ■ Silicone should not be used on unhealed/open wounds. ■ In some cases a rash may occur. If this happens, firstly make sure you are fully cleaning the gel and your skin regularly. Secondly, reduce the wearing time. ■ If the rash persists discontinue its use and contact your therapist. Example of initial wearing schedule for Silicone sheets Day 1 4 hours Day 4 16 hours Day 2 8 hours Day 5 20 hours Day 3 12 hours Day 6 23 hours Pressure Therapy Pressure garments These are made-to-measure garments, fitted accurately to apply pressure to the scarred areas that aim to achieve scars that are flat, soft, pale and comfortable. ■ Your pressure garments should be worn up to 23 hours a day unless otherwise advised to achieve the best possible outcome. They should only be removed for bathing and creaming. ■ Initially you may need to slowly build up your tolerance to the required wearing time. Scar Management 5 NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 6 General information ■ Progress of the scarring and the fit of your garments need to be monitored carefully and regularly and attending your appointments is essential to achieve the best results. You may also be seen before your set appointment date if there are problems. ■ Adults are reviewed around every 3 months (the elasticity of your garments only lasts 3 months. After this optimum pressure is not achieved). ■ Children are reviewed around every 2 months (usually at this stage they have grown and need re-measuring). ■ When new garments are received old garments should be thrown away as they are no longer effective. ■ Your garment does not protect you from the sun’s UVA rays so high factor sun protection creams still need to be applied beneath the garments. Full sun protection needs to continue for 2 years after the injury. You may be able to get your sun cream on prescription from your GP. ■ It is still important to continue with creaming and massage. ■ Your garments should normally be received within 7-10 days from order. Please phone if your garment has not arrived. Silontex This is fabric backed silicone gel sheet that is stitched into your pressure garment. 6 ■ It is only suitable to be used on small areas of scar ■ It is washed in the same way as described for your pressure garment ■ Silontex should not be used on unhealed areas or open wounds. Scar Management NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 7 Washing instructions ■ All your garments must be either hand washed using a mild soap flake product or washed in a 30˚ wash programme. ■ Leave your garments to air dry (to remove moisture you may wrap your garment carefully in a towel). Do not use a tumble dryer. Do not use fabric conditioner ■ If your garment has a foam pad insert, this needs to be washed and dried separately. Precautions If you have any of the following problems please remove your garment and contact your therapist as soon as possible. ■ Changes in circulation causing: - blueness. - swelling in your hands or feet. ■ Abnormal sensation/pins and needles. ■ Sore or broken skin. ■ Damage to your garment. Named Therapist ...................................................... Telephone Number .................................................... NHS Constitution. Information on your rights and responsibilities. Available at www.nhs.uk/aboutnhs/constitution [Last Accessed March 2010] Scar Management 7 NBT002418 Scar Management.qxd:8pp 02/02/2011 10:49 Page 1 How to contact us: H Occupational Therapy Frenchay Hospital Beckspool Rd Frenchay,Bristol BS16 1JE Occupational Therapist 0117 340 3859 www.nbt.nhs.uk/plastics If you or the individual you are caring for need support reading this leaflet please ask a member of staff for advice. © North Bristol NHS Trust. First Published July 2004. This fifth edition January 2011. NBT002418