Hems on skin
Hems on skin – coarse-fibered soyedinitelnotkanny , formed in the place of the previous injury of skin. The fresh hem has pink or red color; old – hypo - or the hyper pigmented coloring. Hems can tower over skin level (hypertrophic), be with it at one level (normotrofichesky), to be involved in skin (hypotrophic). Hems, especially if they settle down on a face and open parts of the body, are esthetic defect of which the person seeks to get rid. For elimination of hems on skin in medicine laser grinding, a dermabraziya, cryotherapy, chemical peelings, injections of steroid hormones, surgical excision are used.
Hems on skin
Rough hems and scars on a face or a body do not serve today as decoration of real men and, especially, women any more. Unfortunately, possibilities of modern medical cosmetology do not allow to get rid completely of cicatricial defects, suggesting to make only them less noticeable. Process of correction of hems demands persistence and patience.
"Hem" and "scar" - words synonyms. The scar is a household, everyday name of a hem. Hems on a body are formed owing to healing of various injuries of skin. Influence mechanical (injuries), thermal (burns) agents, diseases of skin (post-acne) is led to violation of physiological structure of an integument and its replacement with connecting fabric.
Sometimes hems behave very artfully. At normal physiological scarring skin defect is pulled together over time and turns pale. But in some cases scarring has pathological character: the hem gains bright crimson color and increases in sizes. In this case the immediate help of the expert is necessary. In the commonwealth dermatocosmetologists and plastic surgeons deal with a problem of correction of hems.
Formation of hems
The hem passes 4 stages which are consistently replacing each other in the formation:
I - stage of an inflammation and epitelization.
From 7 to 10 days from the moment of developing of a trauma proceed. It is characterized by gradual reduction of hypostasis and an inflammation of skin. The granulyatsionny fabric which is pulling together edges of a wound is formed, the hem is absent so far. If there is no infection or a divergence of a wound surface, then the wound heals primary tension with formation of hardly noticeable thin hem. For the purpose of prevention of complications at this stage the atraumatic seams sparing fabrics are imposed, daily bandagings with local antiseptics are carried out. Physical activity is limited to avoid a divergence of wound edges.
II - a stage of formation of a "young" hem.
Covers the period from the 10th to the 30th days from the moment of a trauma. Collagen-elastinovykh of fibers is characterized by formation in granulyatsionny fabric. The hem is unripe, friable, easily extensible, bright pink color (because of the strengthened blood supply of a wound). At this stage it is necessary to avoid a secondary trauma of a wound and the strengthened physical activities.
III - a stage of formation of a "mature" hem.
Lasts from the 30th to the 90th days from the date of a trauma. Fibers of elastin and collagen expand in bunches and are built in a certain direction. Blood supply of a hem because of what it is condensed decreases and turns pale. At this stage there are no restrictions on physical activity, but the repeated trauma of a wound can cause formation of a hypertrophic or keloidny hem.
IV - a stage of final transformation of a hem.
Since 4th month after a trauma and about one year, there is a final maturing of a hem: dying off of vessels, tension of fibers of collagen. The hem is condensed and turns pale. In this period the condition of a hem and further tactics of its correction becomes clear to the doctor.
It is not possible to get rid of hems once and for all. By means of modern techniques it is only possible to make a rough, wide hem cosmetic more acceptable. The choice of a technique and efficiency of treatment will depend on a stage of formation of cicatricial defect and on hem type. At the same time the rule works: the earlier you asked for medical care, the result will be better.
The hem is formed owing to violation of integrity of an integument (operation, a trauma, a burn, piercing) as a result of defect closing processes with new connecting fabric. Superficial injury of epidermis begins to live without formation of hems since cages of a basal layer have good regeneration ability. The defeat of layers of skin is deeper, the process of healing and vyrazhenny a hem is longer. Normal, uncomplicated scarring leads to formation of a normotrofichesky hem: flat and having color of surrounding skin. Violation of a course of scarring at any stage can lead to formation of a rough pathological hem.
Types of hems
Before choosing a method of treatment and optimum term of holding this or that procedure, it is necessary to define type of hems.
Normotrofichesky hems usually do not bring patients great disappointment. They are not so noticeable since their elasticity is close to normal, they have pale or corporal coloring and are at the level of surrounding integuments. Without resorting to radical methods of treatment, it is successfully possible to get rid of such hems by means of microdermabrasion or a chemical superficial peeling.
Atrophic hems can arise owing to an acne disease or low-quality removal of birthmarks or papillomas. Extensions (striya) also represent this type of hems. Atrophic hems are lower than the level of surrounding integuments, are characterized by the flabbiness of fabrics arising because of decrease in production of collagen. The lack of growth of skin leads to formation of the poles and hems creating visible cosmetic defect. The modern medicine has in the arsenal many effective ways of elimination even enough extensive and deep atrophic hems.
Hypertrophic hems have pink coloring, are limited to the damaged area and act over surrounding integuments. Hypertrophic hems can partially disappear from the surface of skin within two years. They will perfectly respond to treatment therefore you should not wait for them spontaneous disappearance. It is possible to influence small hems laser grinding, a dermabraziya, a chemical peeling. Results introduction to a zone of a hem of hormonal medicines, injections of a diprospan and kenalog in positive results. Electro-and with konraktubeksy, lidazy, a hydrocortisone give lasting positive effect in treatment of hypertrophic hems. Perhaps surgical treatment at which cicatricial fabrics are excised. This way gives the best cosmetic effect.
Keloidny hems have sharp border, act over surrounding integuments. Kelloidny hems are often painful, in places of their education the itch and burning is felt. This type of hems will badly respond to treatment, a recurrence of emergence of keloidny hems still of the big sizes is possible. At all complexity of a task, the esthetic cosmetology has many examples of a safe solution of the problem of keloidny hems.
Features of keloidny hems
Success of treatment of any disease in many respects depends on correctly made diagnosis. This rule is not an exception and in case of elimination of keloidny hems. To avoid mistakes in treatment tactics, it is possible only having accurately defined hem type since on external manifestations keloidny hems often remind hems hypertrophic. An essential difference is that the sizes of hypertrophic hems coincide with the sizes of the damaged surface whereas keloidny hems overstep the bounds of a trauma and in the area can surpass the amount of traumatic injury of skin. Usual places of emergence of keloidny hems – area of a thorax, auricles, are more rare – joints and area of the person. Keloidny hems pass four stages in the development.
- Epitelization stage. After getting injured the damaged site drags on a thin epitelialny film which within 7-10 days is condensed, grows coarse, gets pale coloring and remains in such look 2-2,5 weeks.
- Swelling stage. At this stage the hem increases, towers over adjacent integuments, becomes painful. Throughout 3-4 weeks painful feelings weaken, and the hem gets more intensive reddish coloring with a tsianotichny shade.
- Consolidation stage. There is a consolidation of a hem, in its certain places there are dense plaques, the surface becomes hilly. The external picture of a hem represents a keloid.
- Softening stage. In this stage the hem finally gains keloidny character. It differs in pale coloring, softness, mobility and painlessness.
At the choice of tactics of treatment proceed from a limitation period of hems. Keloidny hems from 3 months to 5 years of existence (young keloids) actively grow, differ in a smooth brilliant surface, red color with a tsianotichny shade. Hems are more senior than 5 years (old keloids) turn pale, get a wrinkled uneven surface (sometimes there is a sticking of the central part of a hem).
Surgical interventions, vaccination, burns, stings of insects or animals, tattoos can be the cause of keloidny hems. Such hems can arise even without traumatic damage. Except essential esthetic discomfort keloidny hems bring to patients unpleasant feelings of an itch and morbidity. The reason of development of this type of hems, but not hypertrophic, at the moment is not established by physicians.
Prevention of emergence of a problem hem
Bearing in mind complexity of treatment of keloidny hems, it is necessary to treat with bigger care prevention of their emergence and to follow certain rules:
- At serious traumatizing integuments of the person it is necessary to ask for the qualified help immediately. The plastic surgeon is able to give timely help which will allow to avoid emergence of keloidny hems.
- Treatment in house conditions has to be directed to an exception of a possibility of suppuration of a wound. Daily processing of a wound surface antiseptics is necessary for an exception of the inflammatory process leading to formation of keloidny hems.
- If a wound small, but its edges strongly disperse, it is necessary to address the plastic surgeon for imposing of an intracutaneous seam and the pulling together bandage at the edges of a seam. Otherwise formation of a keloidny hem is inevitable.
- At early stages of formation of a keloidny or hypertrophic hem (term no more than half a year) it is possible to correct a situation by means of a silicone plate. Application of a rassasyvayushchy plaster under observation of the surgeon will allow to reduce cosmetic defect.
Methods of correction of hems
In questions of treatment of hems you should not act independently: at best the result will be zero, in the worst – you receive even more expressed and rough cicatricial changes. So popular Miderma gels and "Kontraktubeks", of course, help to stimulate regeneration and formation of a normotrofichesky hem, but are not the most effective remedies of fight against scars.
Today in an arsenal of medicine there is a number of effective methods of correction of hems.
Cosmetic medicines. In the presence of a hem it is necessary to pay due attention to home care of skin. The used cosmetics have to contain the components nourishing skin and leveling its surface such as fruit acids and Retinolum. For achievement of the desirable result these means demand prolonged use. Besides, in a sunny weather their use should be combined with sun-protection cosmetics.
Physical therapy. In a hem zone widely apply to stimulation of regeneration processes, blood circulation and a lymph, formation of granulation ultrasonic and electrostatic massage. Fonoforez represents the procedure of introduction of cosmetic and medical medicines to deep layers of skin by means of ultrasound. Ultrasonic waves get deeply into fabrics and, actively influencing at the cellular level, provide their deep warming up and micromassage, stimulate exchange processes, improve blood circulation and a lymph, saturation of fabrics oxygen. The medicinal substances arriving at a fonoforeza collect, forming a peculiar depot, and then are gradually carried with a blood-groove. Fonoforez possesses antiedematous, rassasyvayushchy and anti-inflammatory action.
Electrostatic massage influences fabrics variation electrostatic field, causing their vibration. It leads to improvement of microcirculation and traffic of fabrics, accelerates processes of regeneration and finds broad application in complex correction of hems.
Photocorrection. It is the procedure of masking of a hem under color of surrounding skin due to influence by a light beam. At the same time there is a destruction of excessive pigmentation and vessels of a hem therefore the hem becomes more flat, gets physiological coloring. Photocorrection is carried out at hypertrophic and normotrofichesky hems, red atrophic hems. The number of necessary procedures depends on a look and prescription of existence of a hem and makes to 10 and more. As indicators of efficiency of photocorrection serve clarification of a hem and its softening.
Laser grinding. Influencing a hem, the laser beam layer-by-layer evaporates connecting fabric. The method allows to carry out bystry, bloodless, precisely controlled correction. The procedure is followed by moderate morbidity and hypostasis of skin which are removed after reception of medicines. Laser grinding of a hem is always carried out in combination with other correcting methods.
Cryotherapy. A method of impact on the changed skin ultralow temperatures by means of liquid nitrogen (at t of-40 degrees C), given via the special applicator. Cryotherapy concerning keloidny hems is especially effective, causing their flattening. It is not applied at patients with swarty or dark skin since conducts to a local depigmentation.
Injections. With high degree of efficiency (to 90%) injection introduction to cicatricial fabric of kortikosteroidny hormones is applied to correction of keloidny hems. Collateral reaction of a method is the local pigmentation of skin disappearing over time. Apply injections with hyaluronic acid medicines to treatment of atrophic hems.
Peeling fruit acids. With fruit acids (ANA-peeling) removal of the top layer of the become lifeless cages and stimulation of recovery processes in skin is the cornerstone of a peeling. Fruit acids stimulate formation of elastin and collagen, improve a skin relief, clarify the pigmented zones, narrow pores. The peeling with high concentration of fruit acids smoothes hems and has the rejuvenating effect on skin.
Chemical peelings. The most productive methods of correction of hems are the grindings allowing to level their borders and to level a relief of skin is a laser grinding, a dermabraziya and a chemical peeling. Atrophic hems can be subjected to grinding already on the earliest terms, and hypertrophic and keloidny hems – only after their final formation. Process of grinding of hypertrophic hems has to be gradual: from superficial – to deeper to avoid defect aggravation.
For moderately expressed hypertrophic hems the chemical peeling is carried out step by step. At first within 10 days by means of a superficial peeling (2-4 procedures) skin is prepared for deeper influence. Then 4-7 procedures of a peeling directed to stimulation of recovery processes in a term follow. In addition within three weeks the dermatological cream with silicone protecting skin from drying and an inflammation is appointed. Peeling sessions often combine with the mesotherapy directed to improvement local traffic and microcirculation of skin. After a course of peelings appoint external medicines for maintenance of clinical effect.
The expressed hypertrophic hems at first subject to surgical excision with the subsequent passing of a course of physiotherapeutic procedures ( or ) with fibrinolytic medicines (heparin or gialuronidazy). Then also, in two stages, carry out chemical peelings: at first multifruit peelings of Glicopee S with the glycoleft, lemon, dairy and salicylic acids (several procedures once a week), then - a chemical yellow peeling of Mediderma on the basis of retinolovy acid.
The Retinolovy peeling effectively acts on cellular level, strengthens development of proteins, collagen and elastin, rejuvenates skin. The procedure is well postponed, does not cause discomfort and the expressed skin reactions. Sometimes in addition enter injections of kortikosteroidny hormones into hems (, ). Today peelings are the main method of correction of hypertrophic hems and yield especially good results at an early stage of their treatment.
Recent atrophic hems (two-three a week epitelization) treat by means of mazevy compresses with Dermatiks gel or a protector of Silkses (Mediderma).
Moderately expressed atrophic hems treat by means of superficial and median peelings. They allow to smooth a contour of a hem and to level a skin relief. After the procedure there is small hypostasis and reddening, then the scab (crust) is formed. With falling away of a crust depth of a hem smoothes out.
Microdermabrasion. A method of thin grinding of skin microcrystals an oksi-allyuminiya due to abrasive properties of powder. Microgrinding practically does not cause pain, excludes development of infections of skin in view of use of disposable sets. Microdermabrasion in a complex with method of a bezygolny mesotherapy yields excellent results in correction of hems. Gialuronovy and glutamic acids, vitamins A, E, C, silk proteins, a lysine, oligoelements with the high regenerating and wound healing activity are a part of serums for a mesotherapy.
For softer microdermabrasion oxygen oxide - aluminum mix is used. Saturation of cages oxygen and effect of microgrinding yield good results in fight against hems and extensions.
Radiation therapy. Efficiency of radiation therapy concerning a recurrence of keloidny hems is scientifically proved. However, radiation makes an adverse effect on an organism in general and has too many side effects.
Surgical excision of hems. Excision of cicatricial fabrics a scalpel is directed to reduction of the area of defect. Edges of again formed wound carefully are compared and fixed by an intracutaneous cosmetic seam. Subsequently the accurate postoperative hem is formed.
The fresh keloidny hem cannot be excised – it can lead to its increase and a recurrence. Treatment of keloidny hems is begun with conservative methods, only then resorting to surgical excision. Other types of hems excise after their full maturing, in half a year or year.
To foretell how future hem will look, it is almost impossible. It depends also on individual reaction of an organism, and on healing process course, and on quality of the performed operation. The factors exerting impact on formation of a hem are subdivided into the general and local.
- age features of regeneration of skin: more active in early and slowed down at mature and advanced age
- condition of immune system: content of collagen in a hem depends on activity of macrophages (immune cages) and their influence on fibroblasta (the cage which are responsible for production of collagen)
- hereditary predisposition: individual activity of fibroblast and ability of an organism to concentration of biologically active agents in blood and fabrics.
- place of emergence of damage: in different anatomic zones skin has the special characteristics of blood supply, thickness and a structure of a fatty layer; the qualified operations of the doctor will be allowed to perform a faultless seam in the cosmetic plan
- condition of blood supply of a wound: the result of correction is more favorable where sufficient blood supply (area of the person, head), more slowly the hem will heal in the field of the reduced blood circulation
- nature of a trauma: after burn and lacerations there are deformed hems, for cut wounds with well comparable edges the forecast more favorable; timely surgical intervention will allow to avoid emergence of rough keloidny hems
- size of a wound surface: at extensive damage and the considerable sizes of a hem the favorable result of treatment is possible only at intervention of the skilled plastic surgeon.
It is a little about a shramirovaniye
Information on hems will be incomplete if to ignore such procedure as a shramirovaniye or a skarifikation – artificial drawing on skin of decorative scars. For this one modern direction of a body art – a way to disguise already available hems, for others – attempt to give to the appearance courage and brutality. Unfortunately, thoughtless hobby of young people for similar procedures, and also other artificial injuries of skin (tattoos, piercing) leads to irreversible consequences. The fashion passes, and hems remain forever.