Deliberate self-harm scars: Review of the current literature

Deliberate self-harm (DSH) can be defined as self-inflicted injury without suicidal intent. Treatment of DSH scars may involve a lengthy process and is not commonly treated in its initial stages to allow scar maturation. This review aims to assess the challenges behind scar treatment and outcomes of different surgical methods used to resurface DSH scars.

A review of the literature using CENTRAL, Cochrane, Medline and Embase from January 1990 to February 2016 was conducted. Our search strategy incorporated a combination of MeSH terms "Deliberate self-harm scars" and "self-inflicted scars". Relevant bibliographies of literature were manually reviewed for additional resources. Non-English studies, non-human studies and studies prior to 1990 were excluded.

A variety of techniques were described with including excision and full thickness skin graft reconstruction, excision with Integra resurfacing followed by split-thickness skin graft reconstruction, multiple excisions and laser therapy. A detailed summary of these findings is outlined. All studies reviewed show improved cosmetic outcome in treatment of DSH scars to some degree and no studies reported repeated self-harm.

The literature surrounding the treatment of DSH scars is limited. There is a lack of use of reproducible and standardized scoring systems to compare between studies. The psychology behind DSH and their resultant scars adds another dimension of complexity beyond simple scar reconstruction.

When considering treatment, patient expectations must be carefully evaluated. Research in this area is lacking but understandable due to the nature of the self-harm.