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Practice update: Scarred for life?

Wound healing is a complex process, so it is important to manage the wound correctly and use the right dressings to provide optimal healing conditions.

While a scar is formed as part of the natural healing process following trauma to the skin, this can be problematic for some patients.

Collagen builds up where the tissue is damaged, helping to heal and strengthen the wound. New collagen continues forming for several months and the blood supply increases, causing the scar to become red, raised and lumpy.

The healing and scar maturation process can take anywhere between three weeks and two years. Once matured, the scar differs from normal skin in that it will never attain the normal strength of the surrounding skin. Hair follicles and sweat glands will not grow back.

Healing process

The four stages:


Lasting on average for a few hours and leading to blood clot formation to limit the loss of blood.


Lasting between three and seven days, this is the immune response process to remove bacteria, dead tissue and foreign bodies. This phase causes wound symptoms such as oedema, swelling, changes to skin colour, temperature, burning and itching 


Lasting for around two weeks, this phase is where the wound shifts to tissue repair.

Maturation and remodelling

This is when scar formation occurs. Depending on the size/site of the wound, this can take up to two years.

How can pharmacies help?

Pharmacy teams are ideally placed to give self-care guidance. A large number of wound dressings are available, varying in size, adhesion, conformability and fluid-handling properties. Patients may need to use different dressings at different stages of the healing process or different dressings for different types of wounds. It is useful to speak to local specialist wound nurses and regional units to find out which products they are currently recommending. 

Products available to help minimise the appearance of scarring include:

  • Moisturising oils, creams and ointments
  • Silicone gel sheets or gels
  • Camouflage products.

For optimal results, silicon gel/gel sheets should be used for at least three months. Regularly massaging oil or moisturisers into the scar can also help boost skin hydration and soften scar tissue. Practical advice around lifestyle and preventative measures can also be offered covering:

  • The use of sunscreens and protection. Scars lack melanin and may become bigger, harder and darker in colour if they are exposed to the sun, so it is important to make sure they are protected
  • In the case of stretch marks, measures such as a healthy diet/lifestyle, not “eating for two” in pregnancy and avoiding diets that cause rapid weight loss/gain can help prevent their development.

Venous disease explained

Venous disease, which is typified by sluggish blood flow from the legs to the heart, is responsible for about 70 per cent of chronic leg wounds. 

In patients with venous leg ulcers, the primary culprit is faulty valves in the legs, which allow blood to flow backwards or 'reflux' down the legs. This causes a build-up of persistent high pressure in the leg veins, which damages tiny blood vessels in the surrounding skin. The skin in turn becomes dry, itchy and inflamed, vulnerable to any small break or scratch, which can lead to an open wound with minimal trauma. 

Venous leg ulcers are typically tenacious – characterised by failure to heal and high rates of recurrence. This failure of venous leg ulcers to heal properly is compounded by the poor blood supply to the affected area. Recurrence is also common because, in most cases, the problem with the underlying veins remains. 

The vast majority of venous leg ulcers are currently managed in primary care, with treatment centred on the initial cleaning and dressing of the wound, followed by ongoing use of compression bandages or stockings to boost blood flow in the legs.

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