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Scarring for Black and Dark Skin

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Scars on Black Skin: Treatment, Advice, Cares

SCARRING FOR BLACK AND DARK SKIN:

All breakages of the skin cause a cascade of biological reactions with the skin where the objective is to reestablish its functionality to the best quality and as quickly as possible. Scarring is unfortunately often a complex and unpredictable process, and it is not rare to see defective hypertrophic or keloid scarring processes develop.

In this way, all surgical acts or physical trauma to the skin raise the problem of scarring. It is unpredictable and requires careful consideration of the risk of developing hypertrophic or keloid scars, especially for those who are especially at risk.

 

The different phases of scarring

The skin is a physical envelope for our body. It plays a vital role, acting as a barrier and a regulating influence between the outside environment and the inside environment. In the presence of an acute of chronic wound, the body triggers a complex scarring process where the only objective is to succeed in closing the injured skin. We can distinguish 4 phases in the scarring process:

- The vascular phase or haemostasis

- The inflammatory phase

- The budding or epithelialization phase

- Development and remodeling phase

 

Treating a scar

 

Most acute wounds (traumas, superficial burns, surgical...) evolve towards a normal scarring process, where the scarring time depends on the area, the depth and the texture.

 

Chronic wounds (ulcers, diabetic vascular lesions...) evolve towards a complicated scarring process where prevention tends to be the best treatment. Managing and caring for (chronic) wounds must be done under medical care because of the large risk of necrosis.

 

Many studies have demonstrated that scarring is much quicker in a damp atmosphere than in a dry atmosphere. A 2.5cm² pig wound under occlusive bandaging maintaining a humid atmosphere achieved 90% of scarring in 3 days, whilst scarring was only at 50% for a dry wound in open air. The wound treated with a current of warm air only achieved 18%.

 

Exclusion of antiseptics and antibiotics

The last stage of treatment for an acute wound is to exclude all systematic usage of local antiseptics or antibiotics.

 

The value of using antiseptics on injured skin is minimal compared to their potential side effects (systemic toxicity, germ selection, allergies, causticity...). Washing with saline solution or clear water and soap is sufficient.

 

With respect to antibiotics, it must be clarified that the bacterial flora, except for excess, is not detrimental, it even helps with cleaning. This detersion phase, essentially relates to gram-negative or anaerobic bacteria, which will spontaneously decrease with scarring, to be replaced by gram-positive cocci at the sprouting and epidermisation stages. Local antibiotics are therefore generally useless. Only silver sulfadiazine continues to be regularly used, in particular in burn centres.

 

Maintaining a humid environment for injured skin: bandaging

Plasma exudation (escape of plasma from a cut or wound on the skin) initially constitutes an excellent culture environment due to the fibroblast and epidermis cells, and this must not be disturbed by an overly aggressive attitude (use of certain antiseptics or heavily aggressive bandaging).

Bandages, of all varieties, are the best assets for encouraging, or at least not disturbing, the scarring process, to protect the wound, to control pain, for their breathability, for being well tolerated by the skin, for being easy to change, comfortable, with an acceptable cost/efficiency benefit.

Bandages are classed into 3 large categories which are:

 

  •          Dry bandages (compresses, ready to use bandages)
  •          Moist dressings (the majority of primary dressings)
  •          And cellular and molecular dressings (transition between a dermal-epidermal graft)

To this day, the different bandages available on the marker are spread out between the following large family groups:

 

  •          The hydrocolloids used from the detersion phase up to the scarring phase on exuding wounds.
  •          Hydrogels which are comparable to hydrocolloids but more active on necrotic wounds
  •          Hydroactives are used in lightly or averagely exudative wounds from the detersion phase up to the scarring phase.
  •          Alginates are extremely absorbent and accelerate the detersion process. They have a hemostatic and antibacterial power
  •          Hydrofibres are similar to hydrocolloids and alginates. They can be used from the detersion phase up to the scarring phase. They transform into a gel through their hydrophilic quality  when they come into contact with exuding wounds.
  •          Charcoal dressings are especially used for chronic smelly or infected wounds

 

Keloids

Keloid scarring is defined as a fibrous proliferation from the skin’s root extensions in the form of “crab claws” developing for over 2 years. This is very common for black people and is a real nightmare for young women, especially when they are situated on exposed areas of the skin. The risk factors for keloids are strong pigmentation of the skin (for those with black or dark skin), blood groups (notably type A), age (from puberty to 30) and the location of physical aggression to the skin (sternum, ear lobe, lower part of the face, shoulder blade, neck, pubis), sun exposure of scars.

We have seen above that scarring develops in 4 phases: Hemostasis, Inflammation, Sprouting & Epithelisation, and finally Development and Remodeling. In a keloid, the Sprouting & Epithelialisation phase, also known as the proliferative phase, has an extended duration. This duration extends from the 21 maximum days for normal scars, to several months for a keloid scar. This hyperactivity of the fibroblasts will cause an overproduction of collagen. The absence of collagenase (the enzyme responsible for the destruction of collagen), combined with this overproduction of collagen will cause blistering in the area of the scar. The thus synthesised collagen fibres are 20 times more abundant than in normal skin.

Although the formation of keloid scars is shrouded in controversy, the TGF-β seems to be the principal factor in this abnormal proliferation of fibroblasts and production of collagen. This abnormal production of TGF-β is associated with an abnormally elevated concentration of T lymphocytes, macrophages and Langerhans cells resulting from the differentiation of keratinocytes.

 

Treatment of keloids

Keloid scarring is a pathology specific to human beings (no other animal has developed keloids). This therefore explains the difficulties in understanding the physiopathology of this scarring anomaly, since there are no animal examples.

Although certain treatments exist to reduce the severity, at this time there are no satisfactory therapeutic solutions for this pathology.

The treatment of keloids must be, at best, preventative post surgery, for those who frequently suffer from keloids. After the appearance of the keloid, the most effective treatment generally lies in the combination of various complementary surgical, radio therapy and medical procedures (corticosteroid therapy).

Furthermore, diagnosing a keloid scar poses problems, and this dictates which therapeutic response to make. It’s similarity to hypertrophic scarring make it difficult to make decisions on which therapeutic route to take in the early stages, where it’s development can be the most effectively confused.

 

Some treatments for keloid scars:

- Corticosteroids

- Cryotherapy

- Radiotherapy

- Pressotherapy

- Topical silicone gel

Laser

CONCLUSION ON TREATMENTS

There is no real consensus for caring for keloids. The first choice is still intralesional corticoid injections. If this treatment is ineffective, intra-marginal surgery with or without corticoid injections or other molecules can be attempted.  Radiotherapy must be reserved for only the most difficult cases. Pressotherapy and silicone gels will mainly be used as a preventative measure.

In general, the only way to defend against keloids, especially for the black population who are at risk, is to avoid all non-essential acts of aggression on the skin, especially on the sternum, ear lobe, the lower part of the face, shoulder blade, neck and pubis.


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Comments

Cherche produit cicatrisant efficace - 03/19/16 à 14:12

Bonjour,
Après une opération de la thyroide j'ai un cicatrice au cou que j'aimerai faire disparaitre rapidement quel produit pouvez-vous me conseiller svp ?

Dans l'attente de votre réponse.
Cordialement.


Jeanette kapinga - 04/23/16 à 22:58

Cher
j'ai cicatrices hypertrophiques sur mon visage par une crème que j'avais commandé en ligne à partir de chine , une fois après utilisation
ce qui donne des brûlures cas d'audition.
une fois après avoir utilisé cela ma donne la cause des brûlures ,après la guérison des blessures que , j'ai des cicatrices que je ne peux pas me débarrasser des cicatrices ont maintenant déjà trois mois que je souffre, pouvez-vous me aider avec cette terrible cicatrices sur mon visage


Equipe IN'OYA - 05/02/16 à 14:41

Bonjour,

Vous pourrez traiter la tache laissée par votre cicatrice avec les soins de la gamme MEL'OYA. Pour recevoir des conseils personnalisés, n'hésitez pas à contacter notre équipe par mail à contact@inoya-laboratoire.com !


Equipe IN'OYA - 05/02/16 à 14:45

Bonjour Jeanette,
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- 07/13/16 à 01:59

Bonjour. J'ai plusieurs cicatrices dues aux plaies et certains boutons sur mes jambes. Il nya q sur cette partie qu'ils sortent. Les cicatrices sont là depuis près de 5 ans. Jai tt essayé peut-être un peu tard de atténuer tt cela. Svp pouvez vous me conseiller des remèdes naturels ou autres ?
Ou suis-je condamné à vivre avec ça parce que je désespère. Et mon complexe grandit chaque jour
Merci de votre aide


Sandra ngambou - 09/07/16 à 20:36

bonjour,
J ai moi aussi le meme probleme de cicatrices laissees par des boutons sur les jambes (poils incarnes et folliculite).Ceci a commence peu de temps apres mon arrivee en france (venant d afrique centrale).Pour le moment j ai us de nouveaux boutond.Mais les taches laissees creent un complexe qui grandit petit a petit,m empeche de mettre mes jupes ou maillot de bain en public.j ai l a peau seche au niveau des jambes.je suis de couleur marron.Besoin de vos conseils sur methodes naturelles ou autres..J ai debute il y a 2jours l application du serum mel oya sur les taches chaque soir..J ai essaye tant de produits,jspere enfin pouvoir trouver satisfaction..Merci pour vos futurs conseils.


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