I had a C-section almost three years ago and have a large, red, raised scar as a result. It has always been sensitive, but recently it has started itching terribly. Why and what can I do about this?
- A.B., Jerusalem
Dr. Julian Schamroth, a veteran Jerusalem dermatologist, replies:
The process of wound healing sometimes results in an excessive overgrowth of dense fibrous scar tissue, which causes a hard, raised, red, and sometimes itchy, scar. In most cases, the raised scar is limited to the borders of the injury and tends to subside spontaneously within nine months to a year. Such a scar is called a hypertrophic scar. Occasionally, however, the scar extends beyond the wound borders and persists for years or for life. Such a scar is called a keloid scar.
The cause of keloids and hypertrophic scars is unknown, but there is a strong racial and genetic component: It is more common in dark-skinned individuals and is often hereditary. It is unrelated to the size or nature of the original trauma, and it can even result from a tiny prick such as ear-piercing. There is currently no known method of preventing the scars, and those who already have such scars should avoid non-essential cosmetic surgical procedures. As mentioned earlier, hypertrophic scars tend to resolve in time, so aggressive therapy would not be indicated. These scars could be treated with strong topical cortisone creams to reduce inflammation and irritation, intra-lesional cortisone injections, topical silicone-based creams such as Kelo-Cote C or Mederma C and possibly compression bandages.
Keloid scars can also be treated initially with this therapy, but should the lesions fail to improve, more aggressive forms of therapy should be considered. These include surgical reexcision, irradiation, intra-lesional injections of various anti-cancer agents, interferon therapy or topical creams such as tretinoin or imiquimod. Some recent studies have shown that botulinum toxin (BotoxC) may be of help.
It is my experience that most keloid scars will improve with topical cortisone creams and a series of monthly intra-lesional cortisone injections. This therapy should not only improve the appearance of the scar, but should also markedly decrease the associated itching or irritation.
Sheba Medical Center physiotherapist Roy Bahnov adds:
It would be worthwhile to wear a pressure suit to make the scar more flexible and flat; it can also make it less sensitive. In addition, physiotherapy to smooth, stretch and release the scar could certainly help.
Five years ago, when my daughter was 14, she joined a health club, as she was a little chubby. Unfortunately, although she ate normally at home, she overexercised, lost too much weight in too short a time and became anorexic. She was treated and regained her normal weight. However, five years after this incident, her menstrual period still has not returned. Before joining the army six months ago, her gynecologist put her on contraceptive pills. Will her period ever return? Will she go into early menopause if she stops taking the pill? She has tried all kinds of pills and acupuncture, and nothing has helped. Will she be able to conceive and give birth in the future?
- L.B., Petah Tikva
Prof. Amnon Brzezinski, a senior gynecologist and head of the Women's Health Center at Hadassah University Medical Center in Jerusalem's Ein Kerem, answers:
While you didn't present all the necessary information, it seems that your daughter has hypothalamic amenorrhea. This condition is relatively common among young women and is expressed by a lack of or minimal menstrual periods due to inadequate activity of hormones released by he brain that affect ovarian activity. The phenomenon can be the result of pressure such as weight loss, emotional stress or intensive sports activity. Often, the cause is not known. In any case, the treatment is relatively easy and usually successful. If she does not want to get pregnant now, the best treatment is contraceptive pills. When when she wants to become pregnant, she can be prescribed drugs to trigger ovulation. This usually succeeds in a short time. There is no connection between this condition and early menopause.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to firstname.lastname@example.org, giving your initials, age and residence.