Scars...

[NguuMuu]

What is the mark/scar that many Thai people have on their shoulders? You can notice it on many, many Thai people, especially ladies since they are more likely to wear sleeveless shirts. On some people it is a tiny mark, on others it is a big, ugly scar. What is the reason for this mark, and why is it so big on some while tiny on others? Sorry if the answer to this question is obvious, but I tried searching the internet and this forum to no avail.

[britmaveric]

Small Pox vaccination!!! No clue why some are large and some are not.

[Head Snake]

Some appear to be elimination of ex lover's name tattoo. Of course, I may be wrong as I have done no official research.

Should this be a barladie.com research project?

[VTR1000]

What is the mark/scar that many Thai people have on their shoulders?  You can notice it on many, many Thai people, especially ladies since they are more likely to wear sleeveless shirts.  On some people it is a tiny mark, on others it is a big, ugly scar.  What is the reason for this mark, and why is it so big on some while tiny on others?  Sorry if the answer to this question is obvious, but I tried searching the internet and this forum to no avail.

<{POST_SNAPBACK}>

Don't forget the motorbikes! Asians are generally crap drivers/riders, more so when it comes to women.

[Totster]

I'm thought it was the BCG vaccine

totster

[Galong]

What is the mark/scar that many Thai people have on their shoulders?  You can notice it on many, many Thai people, especially ladies since they are more likely to wear sleeveless shirts.  On some people it is a tiny mark, on others it is a big, ugly scar.  What is the reason for this mark, and why is it so big on some while tiny on others?  Sorry if the answer to this question is obvious, but I tried searching the internet and this forum to no avail.

<{POST_SNAPBACK}>

I think that the size and severity of the scar is the result of scratching. My Thai daughter scraped her knee a while back. It wasn't bad, but she picked at the scab and this resulted in a scar on her knee that's like you've described.

[Khutan]

If the OP is talking about the round scar about the size of 25 satang, then; It deos look like a smallpox vaccine, but some people are too young for that, as smallpox has been eliminated (except to certain labs in the USA).

I think its the scar from the mass Rubella / German Measels innoculations. The scars seem to be more common on the ladies than the men.

[NguuMuu]

So if it's small pox vaccination (or another type), then why is it only noticeable on Thai people? I'm assuming most foreigners get this vaccination in their childhood or at some point in time (I know I did), but I've never seen a foreigner with a mark like the Thais have.

[naka]

Smallpox vaccination, Asian and Negroid people tend to have

a raised scar while Caucasians tend to have a flat scar, no idea why !

[taxexile]

they are keloid scars , probably at vaccination sites.

The keloid is defined as an abnormal scar that grows beyond the boundaries of the original site of skin injury. Keloids have the clinical appearance of a raised amorphous growth and are frequently associated with pruritus and pain

Certain areas of the body such as the sternum, deltoid region of the upper arm, and upper back, have increased susceptibility to keloid formation. These areas are also subject to elevated levels of muscle and skin tension, which may explain their association with keloids. Although levels of skin tension and motion are high in amelanotic areas, such as the palms of the hands or soles of the feet, these areas are not associated with keloids. The most common sites of keloid formation in the head and neck are the earlobes, mandibular border, and posterior neck. The earlobe is typically affected on the posteromedial surface secondary to the posterior positioning of the earring post. The central one third of the face is rarely involved.

Individuals of all ethnic backgrounds can form keloids and hypertrophic scars. Keloids are seen with greater frequency in blacks, Hispanics, and Asians. Prevalence in the black and Hispanic populations can be as high as 16%, and a familial predisposition is believed to exist. Keloid formation is approximately 15 times greater in highly pigmented ethnic groups than in whites.

 

 

 

The treatment of keloids can be subdivided into surgical, nonsurgical, and combined modality treatment. Many published reports advocate a variety of therapies; however, few studies provide a coherent therapeutic plan because of poorly defined endpoints in treatment, inadequate follow-up care, failure to properly distinguish between hypertrophic scars and keloids, and lack of prospective studies. Most of the literature on keloids suggests that a high recurrence rate (50%) is expected, regardless of treatment.

If located in an amenable anatomic location, hypertrophic scars can generally be treated with simple excision, providing wound closure can occur without undue tension. Steroid injections may be appropriate, depending on the particular wound and the patient. Although an injection of intralesional triamcinolone acetate usually flattens the raised scar and decreases pruritus, the discolored or atrophic appearance of the widened portion of the scar remains.

Limitations of steroid treatment must be recognized by the surgeon and the patient to optimize satisfaction with the results. Steroid injections must be administered cautiously to avoid overtreatment, which may result in skin atrophy, telangiectasias, and a depressed scar. In general, scar revision with an excision and atraumatic closure and with possible reorientation of the scar by using W-plasties or Z-plasties can usually improve widened hypertrophic scars. This procedure provides a narrower scar, decreases the tension along the scar, and improves scar camouflage.

Surgical and ablative treatment of keloids

Keloids treated with simple excision have a recurrence rate ranging from 50-80%. The use of Z-plasties or any wound-lengthening technique for excising keloids is strongly discouraged. Complete excision and near-total excision (ie, leaving behind a small remnant of keloid on the peripheral portions of the incision) have both been advocated. The theoretical benefit of the latter is that previously uninjured tissue is not traumatized, decreasing the chances of recurrence; however, whether the residual keloid remnant contributes to further keloid development remains unclear. Wide undermining should be used to make closure of these wounds tension-free. Provided that adjacent tissue is manipulated, wide undermining may or may not increase the risk of keloid recurrence.

The use of cuticular, monofilament, synthetic permanent sutures is advised to decrease tissue reaction. Tissue adhesives may provide a less reactive skin closure, which may decrease the likelihood of keloid formation. Further studies are necessary to evaluate this hypothesis.

Lasers, such as carbon dioxide, pulse dye, neodymium-yttrium aluminum garnet (Nd-YAG), and argon, have been used as alternatives to cold excision for keloids; however, the use of lasers is expensive and cumbersome. Superiority of laser use to simple excision currently has not been demonstrated in clinical trials. Further research and technologic developments may enhance the effectiveness of lasers to treat keloids in the future.

Cryosurgery is a form of ablative modality proposed by certain authors. Zoubolis et al reported a good or excellent response in 61% and poor or no response in 39% of keloid study participants (n=55). The mechanism of action of cryotherapy involves the use of a refrigerant to induce a frostbite-type injury with cellular damage and vascular sludging. The period required to achieve a response is significant, 2-10 sessions separated by 25 days. One of the main adverse effects is hypopigmentation due to injury to melanocytes in the basal layer of the epidermis.

Nonsurgical treatment of keloids

The application of mechanical pressure by compression devices is advocated in the treatment of keloids. Pressure may theoretically break up collagen bundles and soften the keloid mass; however, therapy must be instituted for long periods (>23 h/d for 6 mo) before significant effect can be achieved. Unfortunately, many regions of the head and neck are not amenable to pressure application. Silicone sheeting is used to decrease the irritation and pruritus associated with keloids. The proposed mechanism of action involves maintenance of scar hydration and inducement of a subsequent decrease in cytokine release, resulting in less collagen deposition. Certain authors report great success in keloid regression with this modality. Unfortunately, the general opinion on silicone sheeting does not support significant reduction in the dimensions or pigment characteristics of keloids, although silicone sheeting can be very effective in decreasing pruritus.

Various therapies, including nitrogen mustard, tetroquinone, antihistamines, retinoic acids, zinc, vitamin A, vitamin E, and verapamil, have been used with varying degrees of success.

Interferon (IFN) therapy is used because of its ability to reduce collagen synthesis in dermal fibroblasts. Granstein et al reported a 30% reduction in keloid height after intralesional injections of IFN-gamma 3 times weekly for 3 weeks. As with other treatment modalities, some recurrences are to be expected. IFN has untoward adverse effects, including low-grade fevers, a flulike illness for 48-72 hours after injection, and pain on injection.

Combined modality treatment of keloids

One of the most commonly used combination therapies employs cold-knife excision followed by postoperative injection of intralesional steroid. The injection into the lesion typically occurs 2-3 weeks postoperatively, followed by repeat injection in 3-4 weeks. Preoperative or intraoperative steroid injection may delay wound healing and increase the possibility of wound dehiscence. The most commonly used form of steroid is triamcinolone suspension; however, dexamethasone and cortisone can also be used. A concentration of 10 mg/mL of triamcinolone is used as the starting point and can be increased to as high as 40 mg/mL for denser, more recalcitrant keloids. The lower dose is preferred because of the potential complications of intralesional steroids, including depigmentation and dermal atrophy. The literature, confirmed by clinical experience, reports a negligible

[camerata]

I was told by a Thai doctor that those scars are a result of (mostly) upcountry doctors not knowing how to do vaccinations properly. And some get infected.

[taxexile]

thats probably true , but thais (and others) have a genetic propensity to form keloid scarring as the infection heals , whereas those with less pigmented skin would form less noticeable scarring.