Recommendations for Scar treatment

[kblaze]

Long story short my gf has been left with a grapefruit sized scar on her upper-outer thigh after stepping into a hole on a Chiang Rai sidewalk. This occurred during Songkran and though we applied cream during the healing process, she was still left with a brown/black scar and it seems like the muscle under the skin has even been shifted up and the area is still a bit sensitive.

Though she tries to act like its not a huge deal around me because she knows I feel terrible (im the one who parked the motorcycle at the spot with the hole, she then hopped off the bike, and her leg went down the hole) I know that it has affected her self-esteem and what she chooses to wear when we go out.

Does anyone have any experience with scar-treatment at clinics or hospitals in Bangkok? Any recommendations?

[Sceptict11]

It is likely your g/f has a "keloid" scar.

This type of scar is very common among those with brown/black skin colouring.

Many Thai people will have at least one such scar (often seen in the region of the shoulder)

Treatment tends to be ineffective and can sometimes make matters worse.

If your g/f wants to seek medical advise stay away from "clinics" and arrange to see a Dermatologist either within a government hospital (free for your g/f if she is Thai) or one of the larger private hospitals.

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Edited September 25, 2013 by Sceptict11

[MegaRanter]

In Africa, I do recommend snake fat cream.

But try a dermatologist first.

[TerryLH]

"...and arrange to see a Dermatologist either within a government hospital (free for your g/f if she is Thai)..."

Telling that to someone who doesn't know better is a bit simplistic.

Are there any requirements, or can she go anywhere she wants?

[Sceptict11]

"...and arrange to see a Dermatologist either within a government hospital (free for your g/f if she is Thai)..."

Telling that to someone who doesn't know better is a bit simplistic.

Are there any requirements, or can she go anywhere she wants?

If the said g/f is Thai she knows where she is registered to receive "free " care and how to access such care.

Her knowledge is far greater than mine !

[Sheryl]

She has to go to the hospital where she is registered. If they do not have the necessary specialist, they can refer her to a higher level of care.

[kblaze]

shes been to Camillian hospital, her registered govt hospital, but the guy who looked at it just said "give it time, it'll get better". I feel that would be the response at most govt hospitals, especially as this falls into more of the cosmetic category. Im thinking more along the lines of a private hospital like Samitivej or Bangkok Hospital.

[TallGuyJohninBKK]

There's a dermatologist at St Louis Hospital in the Sathorn area that I think well of... Dr. Thanit (Palanuvej)...

He only works there on most Sunday mornings, like 9 am to 11 am or noon. The rest of the time, he works at the private and pricey Asoke Skin Hospital. Before that opened, he used to be a dermatologist at BNH Hospital, which is where I first met him.

St. Louis is a nonprofit hospital, not government or free. And while I've had bad experiences with a variety of other doctors there, Dr. Thanit hasn't been among those.

You can call the Dermatology and Skin Laser Center at St. Louis and check about his Sunday schedule.

[Sceptict11]

shes been to Camillian hospital, her registered govt hospital, but the guy who looked at it just said "give it time, it'll get better". I feel that would be the response at most govt hospitals, especially as this falls into more of the cosmetic category. Im thinking more along the lines of a private hospital like Samitivej or Bangkok Hospital.

Sounds as if the g/f received good advice.

if you wish to attend a private hospital then as long as you arrange to see a Dermatologist at a major hospital and not a "clinic" she will receive similar good advice.

[Sheryl]

Camellian is a private (though non-profit) hospital. She might be registered there through the govt Social security scheme, but it is not a govt hospital.

That said, it is indeed possible that purely cosmetic treatment would not be covered and would have to be privately paid for. She should make clear to the doc that she understands this.

How long ago did she get this advice? And from which doc? There are 2 derms at Camellian, the one who specializes more in cosmetic issues is Dr. Phairat who is only there on Wednesday mornings.

[TallGuyJohninBKK]

I think it never hurts to get a second opinion, especially when the first opinions rendered by doctors around these parts are so often flat wrong.

The consult at St. Louis in dermatology probably would run 600 to 800 baht, apart from any treatment. Not bad for trying to gain some resolution and domestic peace.

I think the OP's situation depends in part of what kind of scarring has occurred. Is it just an issue of discoloration, or is it actual physical scarring of the skin surface due to the injury.

If it's just discoloration, there are OTC and prescription creams for lightening a darkened area... I had doctors here before prescribe a hydroquinone cream for that.

Actual scarring/physical damage to the tissue would be a different issue.

Here's some commentary from Wiki Answers on scar treatments:

What is the best scar treatment and why?

In: Skin Care [Edit categories]

Answer:

There are very few scar treatments that are backed by science. The following applies to all scars (not just surgical), skin types and all ages.

What to AVOID:

Vitamin E should be avoided as a scar treatment as it causes contact dermatitis (skin allergy) in 33% of users and it does nothing for scar healing. Multiple studies have also shown that Mederma (onion extract) does not improve scars either.

What to DO:

Scientific studies have shown that the following DO improve scar healing and the appearance of scars:

1) Vitamin C
2) Silicone

Both vitamin C and silicone aid healthy collagen production by the skin which is essential for optimal scar healing. Silicone also decreases the production of abnormal collagen that can cause thick, raised scars (which can lead to hypertrophic and keloid scars). Vitamin C also lightens the dark pigment often seen with scarring.

When choosing a product with vitamin C, ensure that it contains a "stable" form of vitamin C. Most forms of vitamin C used in skin care products are unstable and quickly turn brown after the container is opened. This is a sign that the vitamin C has become oxidized and therefore no longer works. Products that are brown to begin with should probably be avoided as many manufacturers color the cream brown so that users cannot tell when the cream becomes oxidized. I would recommend using products that specifically address this vitamin C stability issue (the ones that do usually mention it on the packaging and are not brown).

Your scar treatment of choice should be used as soon as initial scar healing has occurred and you can comfortably apply the scar treatment/scar cream without much discomfort. Continue using the scar therapy until you no longer see any improvement in the appearance of the scar. This can take 6 - 24 months.

http://wiki.answers.com/Q/What_is_the_best_scar_treatment_and_why

Edited September 26, 2013 by TallGuyJohninBKK

[Sceptict11]

Hydroquinone banned, I believe, by the American FDA and by European authorities !

​Not something I would use or recommend!

[kblaze]

Camellian is a private (though non-profit) hospital. She might be registered there through the govt Social security scheme, but it is not a govt hospital.

That said, it is indeed possible that purely cosmetic treatment would not be covered and would have to be privately paid for. She should make clear to the doc that she understands this.

How long ago did she get this advice? And from which doc? There are 2 derms at Camellian, the one who specializes more in cosmetic issues is Dr. Phairat who is only there on Wednesday mornings.

You're right Camillian is private. thanks for this, we'll check out Dr. Phairat, I'm not sure which she talked to last. She went in after we got back from Chiang Rai from songkran, then again about 2 months ago, and that was when whoever she saw told her to just wait.

[TallGuyJohninBKK]

I didn't recommend taking any medicine, although that's what doctors here have prescribed to me in the past...

I did, however, recommend seeing a dermatologist for a second opinion.

And, from what I can gather, while there was a U.S. FDA proposal to ban OTC hydroquinone products back in 2006, I'm not sure it was ever enacted. And, more to the point, the concern was over oral ingestion of hydroquinone as a possible carcinogen... not its topical application to the skin.

Here's what the Harvard Medical School's publication wrote in 2007.

Hydroquinone. Many dermatologists consider this cream the best choice for treating age spots. You can expect to see results in four to six weeks, with the greatest improvement after four to six months. The most common side effect is irritation or reddening. The FDA recently proposed a ban on over-the-counter preparations containing hydroquinone because studies found that the drug may cause cancer when fed to rats and mice. So far, there are no studies showing any increased risk to humans using the drug topically. The FDA is still responding to challenges from critics who oppose the ban.

http://www.health.harvard.edu/press_releases/topical-treatment-for-age-spots

[Sheryl]

Hydroquinone won't do anything for a scar. Depending on its depth and size, there may be laser or surgical options. In most cases this won't completely eliminate the scar but may succeed in making it smaller, less unsightly.

[TallGuyJohninBKK]

I believe, that's what I said before...

I think the OP's situation depends in part of what kind of scarring has occurred. Is it just an issue of discoloration, or is it actual physical scarring of the skin surface due to the injury.

If it's just discoloration, there are OTC and prescription creams for lightening a darkened area... I had doctors here before prescribe a hydroquinone cream for that.

Actual scarring/physical damage to the tissue would be a different issue.

[dddave]

I remember that "NOXZEMA" skin cream used to be touted as effective in removing age spots and blemishes. Was Hydroquinone the active ingredient in that product?

I haven't seen it advertised in ages.

[TallGuyJohninBKK]

Noxzema is great as a facial cleanser... I've used it for years...and still do here...

But it doesn't contain any hydroquinone, and AFAIK, doesn't do anything for age spots...

I haven't had a blemish on my face in years, though!