REF: T18/10 General Commissioning Policy Statement Treatment Scar Revision and Skin Resurfacing For the Severe Scarring treatment of Background This commissioning policy is needed because scar revision is currently on the PCT list for treatments not routinely commissioned and requests are thus currently considered via the Exceptional Treatments process. Commissioning Scar revision that is considered to be cosmetic will not be position routinely commissioned by NHS Hull, as cosmetic treatments are low priority. Scar revision may only be considered in exceptional circumstances in individuals where: the scar has resulted from previous NHS surgery where the quality of work has been poor OR scarring is due to burns OR severe trauma AND there is evidence of significant clinical symptoms, psycho- social problems or functional impairment and a clinical opinion that scar revision is likely to ameliorate these problems. Skin Resurfacing involves removing the top layer of skin with an aim to make it look smoother and healthier. Scarring and permanent discolouration of skin are rare complications. Skin Resurfacing treatments (by techniques including laser, dermabrasion and chemical peels) requested for skin rejuvenation or other cosmetic purposes are not commissioned by NHS Hull as cosmetic treatments are considered low priority. Skin resurfacing may be considered on an exceptional case by case basis for: post traumatic scarring severe facial post-acne scarring, only when the active disease is controlled. Requests for treatment will need to provide evidence of: severe psychological distress, OR adverse physical health effects AND compelling reasons to believe that skin resurfacing will lead to an improvement in health status. Notes 1. This Policy will be reviewed in the light of new evidence, or guidance from NICE. 2. General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull. REF: T18/10 All requests for scar revision and skin resurfacing should include a detailed account of the specific problems encountered along with any previous referrals, treatments and outcomes. Photographic evidence in support of the individual case may assist the decision making process. (NB. Treatment for Port Wine Stains on the face and neck is subject to a separate Policy statement). Effective from July 2010 Summary of Scarring can arise from trauma, surgery or skin conditions such evidence / as severe acne. Scar revision is designed to improve or disguise rationale the appearance of scarring. Scars from an injury or operation tend to improve on their own with time and therefore surgery to revise this type of scar is not usually carried out for at least six months afterwards. Scar revisions can be carried out under either general or local anaesthesia. Treatments vary according to the type and size of the scar. Some scars are cut out and re- stitched carefully. Other scars are removed by abrasion or laser surgery and require no stitching. In line with the Modernisation Agency guidelines for Plastic Surgery (Ref 1), cosmetic surgery (surgery undertaken exclusively to improve appearance) is excluded from NHS provision in the absence of previous trauma, disease or congenital deformity. In exceptional circumstances and after consideration by the ETP, NHS Hull may consider individual cases in line with this policy. Scarring and keloid formation are possible consequences of acne, especially in nodulo-cystic acne. A range of laser treatments has been used for the management of acne scarring. A Cochrane systematic review in 2001 concluded that even though the available studies of laser resurfacing for acne scarring were poor, there was some evidence to suggest that the treatment was effective (Jordan et al 2001). There was little evidence at that time of which type of laser worked best for which type of scarring. More recent studies have considered the type of laser and the method of use (Woo et al 2004) but there remains a paucity of good controlled studies. (Ref 2) Date July 22nd 2010 Policy to be July 2012 reviewed by Contact for this Julia Mizon, policy Assistant Director (Contracting and Performance), NHS Hull Julia.Mizon@hullpct.nhs.uk Notes 1. This Policy will be reviewed in the light of new evidence, or guidance from NICE. 2. General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull. REF: T18/10 Refs: 1. Commissioning Guide - Referrals and Guidelines in Plastic Surgery (NHS Modernisation Agency 2005). 2. Schofield, Grindlay and Williams (2009). Skin Conditions In The UK: a Health Care Needs Assessment. Centre of Evidence Based Dermatology, University of Nottingham, UK Notes 1. This Policy will be reviewed in the light of new evidence, or guidance from NICE. 2. General Commissioning Policy Statements are agreed by the Commissioning Executive on behalf of NHS Hull.