Treating Self Harm Scars

Dr Helena Torpinski|General dermatology
19 March 2020


In this second part to our self injury or self harm series, we’re looking at treating self harm scars.

By the time we see patients living with self harm scars in our clinic, they’ve usually tried a range of scar reduction treatments, such as Bio Oil, silicone gel sheets & pressure dressings.

Some have tried more serious measures, such as artistic or medical tattooing or even skin grafting to the affected areas. And most patients try diligently to camouflage scars with make up.

The good news is, most self harm scars are treatable.

There are a number of different types of scars that are the common results of self injury behaviours. Each scar has a different treatment approach with lasers, often requiring two or three different types of lasers to address each of the issues present.

It’s because of the complex nature of scars that we recommend treatment at a clinic that has numerous lasers available for use. A single laser simply can’t address the various elements of most scars.

Below, we discuss the common self injury scar types and the treatments usually required to achieve a good result.

Self injury scar types and their treatments

Linear Scars

These are scars that are raised, dented, pale or erythematous. They can be mature (light in colour and flat) or immature (red, sometimes itchy or painful but many will mature to become flat).

Once mature, these scars may assume pigmentation similar in colour to the surrounding skin, but can settle as paler or darker.

Most often, these scars are seen on arms and thighs.

Treating linear self harm scars

We use a Fraxel laser to blend the scars into the surrounding background by improving both colour and texture.

If needed, a vascular laser can reduce the erythema in the scar and a pigment laser can reduce the surrounding pigmentation so there’s less visual contrast.

Keloid Scars

Keloid scars are focally raised, can be itchy at times and are red or pigmented. They can continue to grow or spread for many years, specially in younger patients.

Keloids invade the surrounding normal skin, depending on the site of the scar.

Sternal keloids commonly develop a butterfly shape. They can grow large lobules, called “earlobes”, and linear sections called “limbs”.

Treating self harm keloid scars

Most often, keloid scars are treated with a vascular laser to improve the redness and then intralesional steroid injections are given to flatten the scar and reduce itching.

Hypertrophic scars

These scars are raised, red and itchy at times. They can mature into an elevated, ropey appearance.

Treating self harm hypertrophic scars

We commonly use a Fraxel laser to address the textural issues of these scars, and then a vascular laser to reduce redness.

Contracture scars

When scars cross joints or skin creases at right angles, they are prone to developing contractures.

They typically have disabling and dysfunctional properties and are the most common form of scarring from burns.

Treating self harm contracture scars

A Fraxel laser is used to soften the scar and re-establish a more normal skin texture. Steroid injections can then be used to reduce the inflammatory component.

Atrophic scars

These are flat scars that are depressed below the surrounding skin. They’re most commonly associated with acne or chicken pox, but they’re also the scarring that results from chronic picking.

Treating self harm atrophic scars

These scars are treated with a Fraxel laser which improves texture through neocollagenesis, and it disperses some of the surrounding pigment.

Skin graft scars.

Skin grafts change colour over time, initially appearing red and swollen and then usually settling to a paler and flatter appearance.

However, they are often mismatched to the surrounding skin due to redness, pigmentation, the amount of sun damage and, at times, hair growth.  The edges of grafts may be puckered or dented also.

Treating self harm skin grafts

Fraxel lasers will attend to the textural mismatch and the graft edge. A vascular laser can then be used to treat the neovascularisation of the graft or flap edge. Finally, pigment lasers can blend the mismatched skin colours, leaving them less disparate.

Can your self injury scars be treated with lasers?

As with all laser treatments, our dermatologist must review the scars and ensure the correct lasers and treatment pathway is determined for your skin, your scars and any other conditions that may affect treatments.

While most scars are treatable, there are some that will not be appropriate to treat with lasers, or for which laser treatments simple don’t return the desired results.

In your consult with the dermatologist, you’ll be given information on all your treatment options and the likely results that can be attained.

You can read more about what’s involved in a scar treatment appointment on our self harm scar treatment webpage.

If you’d like to book a consultation with our dermatologist to talk about treating self harm scars, please call our receptionists on (02) 9953 9522. A GP referral will mean you can receive the medical rebate, which covers a portion of the cost of your consultation. Our receptionists will have more details.

If you are worried about you or your child self harming

As mentioned above, we recommend seeking professional help for self harming cases. Your GP can be a great first step and will have all the necessary information.

You can also find helpful information from:

The Black Dog Institute

Beyond Blue