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Self-Harm Scars — SCE Dermatology MCQ

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ModeratePsychodermatologySelf-Harm ScarsSCE Dermatology

A 28-year-old woman has a long history of self-harm with cutting. She presents with multiple parallel linear scars of varying ages on her forearms. She is currently under psychiatric care and her mental health is stable. She asks about scar improvement. What is the most appropriate dermatological approach?

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Correct answer: E — Offer scar assessment and discuss treatment options (silicone gel sheets, pulsed dye laser for erythematous scars, fractional laser for mature scars) with continued psychiatric support

Patients with self-harm scars may experience significant psychosocial distress from their scars, even after psychiatric recovery. A compassionate, non-judgemental dermatological approach is appropriate. Scar treatment options include: silicone gel sheets/cream (for raised/hypertrophic scars), pulsed dye laser (for erythematous/immature scars), fractional laser resurfacing (for established scars), camouflage cosmetics, and medical tattooing. Assessment should include scar age, type (atrophic vs hypertrophic), colour, and patient expectations. Treatment should occur alongside ongoing psychiatric/psychological support. BAD psychodermatology guidelines support a holistic approach addressing both the physical and psychological aspects of skin-related distress.

Reference: BAD 2020 Psychodermatology Guidelines