My 6 yr old had stitches removed from her forehead a week ago. The wound has been kept covered by steri strips, and when I last changed them, I noticed the scab is still present. When should I begin to massage the scar, and what topical ointments/treatments are best to minimize the scarring?
When to Begin Massage and Ointment of a Scar from Stitches? (photo)
Doctor Answers 1
Minimising child's facial scar
These are great questions and thanks for the photo!
It sounds as though your 6 year old had the injury approximately 2 weeks ago, so scar massage can be started now. There are a variety of commercial products that can be used, but it is not necessary to spend large sums of money on a topical scar reducing product. If massaging is uncomfortable for your child while the scab is present then restrain your enthusiasm and go gently until it falls off.
Paper adhesive tape (like Micropore tape) is useful in supporting the wound and reducing sun exposure. It is made in flesh-coloured and white. To use, cut a length that is slightly longer than the scar and place it along the scar, pressing down to adhere the tape to the skin as you do when applying steri strips. The tape can be changed daily, or left in place for 3-4 days until it starts to lift up at the edges. It is best to change it when the tape is dry, as it can be more adhesive when wet.
The use of topical silicone has been shown to reduce scarring. Your local pharmacist will likely stock silicone sheeting or gel. I recommend the sheeting in preference to the gel formulation, except where using the sheeting is impractical.
Deciding whether to use the paper tapes or the silicone largely comes down to patient/parental preferences and concerns.
Sun protection of the scar is very important in the first 6 months. Scars are more likely to have pigmentation abnormalities if they are exposed to the sun, and having hypopigmentation or hyperpigmentation makes the eventual scar look more noticeable.
The scab that is visible in the photo will come off in the next 1-2 weeks. Do not try to encourage it to come off, it will lift when ready.
It is unlikely that the scar will start to become hypertrophic or keloid, but if it does you may wish to seek further advice from a plastic surgeon regarding the use of silicone sheeting or other treatment modalities.
I hope this helps. Good luck! JT