Itching can be a disabling symptom in scars. It is most commonly seen in hypertrophic burn scars, but almost any scar can be itchy. At its worst, it can be intensely distracting and disturb sleep. Itch is caused by the chemicals released in the scar irritating local nerves. The Scar Team approach the treatment of itch through several approaches. Most frequently, all that is required is for the top layer of the skin – the epidermis – to be more moisturized. The locking in of water can dampen down inflammation and it is a normal function of uninjured skin. Moisturization can be produced by regularly applying simple emollient creams. Silicone sheets and ointments are believed to partially act through this mechanisms. Applying creams when they are fresh from the fridge also seems to soothe and dampen down symptoms. More intense or frequent itching may be approached in a number of ways. It may be a sign of a scar that is worsening and to this end, a rapid assessment by our team may result in a recommendation for more invasive scar treatments such as corticosteroid injections. However, more frequently simple medications may help and these can include antihistamine tablets or more powerful drugs that alter the transmission of nerve cells. An example of the latter group is gabapentin. A relatively new approach is the injection of botulinum toxin into scars. There have been some excellent recent publications showing that Botox, in the same way as it acts to send muscles to sleep temporarily, also blocks similar nerves that are oversensitive to itch. Such injections are offered by The Scar Team when other approaches have not been successful.
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