Four years ago, my husband, Tony, 82, had triple heart surgery and his scar is now super sensitive. He has tried treatments including Bio-Oil and steroid strips.
Do you know anything worthwhile?
It would be lovely to give him a spontaneous hug without fear of hurting him.
Maggie Hendey, Isle of Wight.
Maggie Hendey inquires about the scar on her husband’s chest, which is very sensitive after his triple heart surgery
The photograph you enclosed shows redness and swelling on your husband’s chest — an excessive response to the surgical incision four years ago.
Usually by this stage you’d expect the scar to be just a thin, white line.
There are two types of abnormal scarring — keloid and hypertrophic scars. Keloid scars are red, angry-looking, lumpy and larger than the original wound — they do not improve.
A hypertrophic scar looks very similar to keloid scarring, but it doesn’t grow beyond the edges of the wound.
Hypertrophic scars also often get larger and redder for a few months, before shrinking back to a more normal appearance over a couple of years.
Both types are the result of abnormalities in the wound healing process.
Normally when a wound heals, inflammatory reactions trigger the formation of new blood vessels and the production of skin cells and fibroblasts, which make collagen, the protein that gives skin its elasticity.
Hypertrophic and keloid scars occur when too many fibroblasts and too much collagen are produced.
The exact reason for this is unclear, but we do know that genetic factors play a part in keloid scars.
As well as often being unsightly, these scars can cause pain or itching.
Keloid scars are red, angry-looking, lumpy and larger than the original wound — they do not improve. A hypertrophic scar looks similar, but doesn’t grow beyond the edges of the wound
The scar in your photograph looks like a keloid at the top and a hypertrophic scar at the bottom. Treatment can make a difference to its appearance and any pain or itchiness.
This typically involves injecting a corticosteroid (triamcinolone) into the scar, four to six times over the course of six months.
This suppresses inflammation and is effective at stopping the pain and softening and flattening the scar.
Some doctors prefer to prescribe a tape impregnated with a steroid (called Haelan), which is worn for 12 hours a day for several months.
In my experience, both work well, but the best results are when they’re used in the first year after the original injury.
Another effective treatment is injections of 5-fluorouracil, a chemotherapy drug that suppresses the fibroblast activity. But this is best reserved for when steroids are unsuccessful.
Treatment for keloid- and hypertrophic scars typically involves injecting a corticosteroid (triamcinolone) into the scar, four to six times over the course of six months
Radiotherapy can also dampen this fibroblast activity. But many plastic surgeons and dermatologists are reluctant to use it because of the potential, although rare, for it to cause cancer.
Lasers are also an option, but while some have been shown to help, we don’t know exactly how effective they are and they are not universally available on the NHS.
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email email@example.com – including contact details.
Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.
It’s possible to ‘remove’ the scar by cutting it out under local anaesthetic and then preventing an abnormal scar from forming by applying the corticosteroid tape as soon as the new wound has healed — which could be four weeks — and continuing it for six months.
Merely cutting out the scar with no subsequent treatment would probably result in further scar hypertrophy or keloid formation.
I’d suggest this might be the option for your husband — your GP would have to agree and make a referral to a plastic surgeon or dermatologist.
But it is unacceptable that the scar should be so tender four years post-surgery, so some action is advisable.
My 17-year-old daughter, who weighs 6.5 st to 7 st, has terrible indigestion whenever she eats, and stomach pains and acid reflux when she goes to bed.
She’s been prescribed Nexium but it hasn’t worked. She also takes Gaviscon Advance.
A camera was put down her throat, but this only found slight inflammation at the top of her stomach.
Have you any suggestions?
Name and address withheld.
Your concern is understandable. At 7 st she is very lightweight, though without knowing her height I cannot speculate on this further.
The report from her endoscopy (the procedure you mention) is reassuring.
As you say in your longer letter, not only has it excluded hiatus hernia — where part of the stomach squeezes up into the chest through an opening in the diaphragm — but it shows there is no noticeable inflammation in the lining of the oesophagus, which rules out significant acid reflux as the cause of the pain.
If the pain is in the abdomen (possibly spreading to the shoulder blades) and is triggered by eating, there is a small chance it might be due to gallbladder disease
Ulcers have also been excluded as the cause. One of the key things to check is where — and when — the pain occurs.
People usually use ‘indigestion’ to describe pain high up in the abdomen.
But if the pain is in the abdomen (possibly spreading to the shoulder blades) and is triggered by eating, there is a small chance it might be due to gallbladder disease — where stones form in the gallbladder.
Second, I must mention a disorder called bile reflux, which causes radiating pain behind the breastbone, sometimes up to the throat.
Bile, produced in the liver and delivered into the small intestine, is an alkaline fluid that helps in the digestion of fats.
In some patients, this can flow in the wrong direction and, when refluxed up into the oesophagus, causes pain.
In some patients, bile fluid can flow in the wrong direction and, when refluxed up into the oesophagus, causes pain
An acid suppressant such as Nexium, the drug your daughter was prescribed, won’t help with this, nor will an antacid such as Gaviscon (which neutralises acids made by the stomach).
Bile reflux is usually an intermittent problem and there are no specific medicines for it. Direct observation during an endoscopy is the only way to prove bile reflux.
Finally — and this is a more sensitive subject — could it be that these symptoms are a manifestation of an eating disorder?
Her pain may be a reason to avoid eating, and it is vital to consider this. Has she lost weight since the symptoms started? And have her periods stopped or become infrequent?
The opinion of a state-registered dietitian (steer clear of anyone labelled ‘nutritionist’) could be of value.
You will need a referral from your family doctor, with whom it is important to have an ongoing conversation about this significant problem.