Scars: types, healing and treatment options

A scar is the visible result of the skin repairing itself after damage. The NHS says a scar is a mark left after a wound or injury has healed, and that most scars fade over time without treatment. Fading is slow: the NHS gives a timescale of up to 2 years or more, so a scar that looks pink, red or raised at 3 months is often still maturing.

Scars can be pink, red, purple, white, brown, skin-coloured or darker than the surrounding skin, and they can be itchy, painful or uncomfortable. Colour and texture often change as the scar matures, which is why clinicians usually avoid judging a scar too early.

The NHS lists five types of scar and what each looks like. Telling them apart matters because the treatment and the likelihood of improvement differ.

Both are raised, but they differ in how they grow. A Kingston and Richmond NHS Foundation Trust leaflet describes hypertrophic scars as red and raised, not extending beyond the original wound, possibly thickening for up to 6 months and usually improving within 12 to 24 months. Keloids can grow beyond the wound boundary and may be painful and itchy.

The NHS says a keloid usually appears a few weeks to years after an injury such as a cut, burn or acne, and is more likely in people aged 10 to 30, people who are pregnant, people who have had one before, and people of south Asian, Chinese, African Caribbean or Black African origin. It is most common on the chest, shoulders, chin, neck, lower legs and ears. The NHS suggests that people prone to keloids avoid tattoos and piercings and treat acne early.

The NHS advice is simple. Massage the scar with a water-based cream such as aqueous cream a few times a day, but only once the wound has fully healed. Keep the scar covered with clothing or a dressing when in the sun for at least a year, and apply sunscreen of SPF 30 or more.

A pharmacist can recommend silicone dressings or gels and massage creams. For scars that are noticeable, the NHS describes skin camouflage: special creams and powders colour-matched to your skin by a trained professional. A GP can refer you for a camouflage appointment, or you can refer yourself online, and the products can be prescribed or bought.

If a scar is severe or bothering you, the NHS says a GP may recommend treatment or refer you to a specialist, with the aim of improving how it looks rather than removing it. Depending on the type, options include silicone dressings or gels, steroid injections or cream, cryotherapy (freezing), laser therapy and skin camouflage.

For keloid and hypertrophic scars, the NHS leaflet from Kingston and Richmond describes a course of steroid injections to soften and flatten the scar and ease pain and itching, sometimes with silicone, cryotherapy or laser. It says early treatment can stop a keloid or hypertrophic scar growing, and that surgery is generally not recommended because of the risk of regrowth at a larger size.

Scars on the face, hands or other visible areas can affect confidence, and a scar linked to an injury or illness can carry painful memories. The NHS says a GP can refer you for talking therapy if a scar is affecting your mental health. The NHS also points to Changing Faces for information on skin camouflage.

See a GP if a scar is painful or bothering you, or if you think it is a keloid, as early treatment may stop it growing. Ask for an urgent GP appointment or call NHS 111 if a scar is swollen or painful, feels warm, or has pus coming out, because these can be signs of infection.