Simone Lawson
Scars are an abnormal healing response of the skin to injury, resulting in atrophic scars (skin depressions) or hypertrophic scars and keloids (elevated). The formation of scars involves the intricate and coordinated mechanisms of tissue repair after injury. This process includes the inflammatory phase, the proliferative phase, and the remodeling phase, which involves scar maturation. The inflammatory phase is characterised by the influx of inflammatory cells and immune cells, which initiate the process of wound closure. Subsequently, fibroblast cells arrive at the wound site, producing connective tissue and collagen, which are essential for scar formation. The amount of collagen produced during this process determines whether a scar will be raised or flat. The maturation process of scars involves tissue remodelling, with a decrease in inflammation, blood vessels, collagen fibres, and fibroblasts. This process can be prolonged in some cases, leading to pathological scars.
| Characteristics | Values |
|---|---|
| Definition | An area of fibrous tissue that replaces normal skin after an injury |
| Formation | Scars form as part of the healing process after the skin has been cut or damaged. The skin repairs itself by growing new tissue to pull together the wound and fill in any gaps caused by the injury. |
| Tissue composition | Scar tissue is made primarily of a protein called collagen. |
| Tissue structure | The fiber composition of the protein is different from that of normal tissue. Instead of a random basketweave formation, collagen cross-links and forms a pronounced alignment in a single direction. |
| Appearance | Scars often look darker, lighter, pink, red, purple, white, brown, skin-coloured or darker than the surrounding skin. |
| Texture | Scars have a different texture and quality than the surrounding tissue. |
| Types | Keloid, hypertrophic, atrophic, contracture, flat, fine line, stretch marks |
| Treatment | Pressure therapy, massage therapy, scar-revision surgery, laser resurfacing, filler injections, microneedling, cryosurgery, platelet-rich plasma (PRP) therapy, punch grafts, radiation therapy, silicone ointment, corticosteroid cream, silicone gel sheet, skin-lightening cream, silicone dressings, gels, creams, powders (skin camouflage) |
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What You'll Learn
- Scars are formed as part of the body's healing process
- Scar tissue is made of collagen, which gives scars a different texture
- Keloid scars are caused by excess collagen and are more common in darker-skinned people
- Atrophic scars are indented and caused by a lack of tissue
- Scars can be treated with pressure therapy, surgery, or topical creams
Scars are formed as part of the body's healing process
The process of scar formation begins with hemostasis, where blood clots to stop bleeding and form a scab. This is followed by the inflammation stage, where white blood cells arrive to fight infection and clean the wound, which may become red, swollen, and tender. During the proliferation stage, new tissue, blood vessels, and collagen fibres form to fill the wound, and the scab may loosen or fall off. In the final maturation stage, collagen fibres reorganise, and the scar becomes smaller and paler, which can take months or even years.
There are several types of scars, including contracture scars, which often develop after burns and cause the skin to tighten; atrophic or depressed scars, which are sunken and caused by a lack of tissue; flat scars, which may be slightly raised initially but flatten out as they heal; and hypertrophic or raised scars, which form due to excessive connective tissue. Keloid scars are another type of raised scar that spreads beyond the wounded area and can occur on anyone, especially those with dark skin. Stretch marks or striae are also considered a form of scarring caused by rapid skin stretching or tension during the healing process.
While scars cannot be completely removed, various treatments can help improve their appearance and reduce their size. These include pressure therapy, massage therapy, scar-revision surgery, and topical creams or ointments. It is also important to protect scars from the sun by keeping them covered or using sunscreen with a high sun protection factor (SPF).
Scars are a natural part of the healing process, and their formation can be influenced positively by early treatment. They can have a significant impact on a person's quality of life, and seeking treatment can help improve mobility and restore aesthetics.
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Scar tissue is made of collagen, which gives scars a different texture
Scars are a natural part of the healing process after an injury. They occur when the skin repairs itself by growing new tissue to fill in any gaps caused by the wound. This new tissue is called scar tissue and is primarily made of collagen, a fibrous protein that is also found in normal skin tissue.
Scar tissue is made of the same collagen as the tissue it replaces, but its composition is different. In normal tissue, collagen fibres are arranged in a random basketweave formation. In scar tissue, however, the collagen cross-links and forms a pronounced alignment in a single direction. This realignment of collagen fibres gives scars a different texture and quality compared to the surrounding tissue.
The amount of collagen present in a scar also varies depending on the type of scarring. For example, hypertrophic scars occur when the body overproduces collagen, resulting in a raised lump on the skin. Keloid scars, on the other hand, are caused by the uncontrolled proliferation of collagen that extends beyond the original wound margin, forming a bulge on the skin. These types of scars can continue to grow indefinitely and are more common in people with dark skin.
Atrophic scars, on the other hand, are indented scars that occur when there is a lack of tissue during healing, resulting in a sunken appearance. This type of scarring is often associated with acne, chickenpox, or other diseases. Stretch marks are also considered a form of scarring by some and are caused by rapid skin stretching or tension during the healing process.
While scars will never completely disappear, there are treatments available to reduce their size and improve their appearance. These include pressure therapy, surgical scar revision, laser resurfacing, filler injections, microneedling, cryosurgery, and platelet-rich plasma therapy. The aim of scar treatment is not just to regain mobility but also to restore aesthetics, as scars can significantly impact a person's quality of life.
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Keloid scars are caused by excess collagen and are more common in darker-skinned people
Keloid scars are a form of excessive scarring caused by the overproduction of collagen. This overproduction results in large, tumorous (although benign) neoplasms that can grow indefinitely beyond the boundary of the original wound. Keloid scars are characterised by thick, large, closely packed bundles of disorganized collagen. The exact mechanism behind keloid formation is not fully understood, but it involves a loss of control of normal healing mechanisms, with a combination of cell proliferation and abnormal apoptosis.
Keloid scars are more common in people with darker skin types, particularly those of African, Asian, Latin-American, or Hispanic descent. People with a family history of keloids are also more susceptible to developing them. While keloids can occur on anyone, the risk is significantly higher for those with darker skin pigmentation. This increased risk is suggested to be related to higher levels of melanin, the pigment that gives skin, hair, and eyes their colour.
The formation of keloid scars involves the abnormal proliferation of fibroblasts and the excessive production of collagen, specifically type I collagen. This excessive collagen production results in the characteristic raised appearance of keloid scars, which can be either soft and doughy or hard and rubbery to the touch. The excess collagen forms dense sheets with a random orientation, in contrast to the distinct collagen bundles found in normal skin.
Keloid scars are typically found on the shoulders, chest, neck, abdomen, and ears. They can vary in size and may sometimes hang by a stalk, moving slightly when touched. Keloids often cause discomfort and can be itchy or painful. While they are benign and harmless, they can be a cosmetic concern for some individuals.
The treatment of keloid scars can be challenging due to their high recurrence rate. Surgical removal is an option, but it may not be permanent as keloids tend to recur after excision. Other treatments include radiation therapy, pressure dressings, and silicone gel sheeting. Pressure therapy, which involves applying pressure to the wound during the healing process, can help prevent or reduce the size of keloid scars.
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Atrophic scars are indented and caused by a lack of tissue
Scars are a natural part of the body's healing process. They are formed when the dermis, the deep and thick layer of skin, is damaged. The body then forms new collagen fibres, a naturally occurring protein in the body, to mend the damage, resulting in a scar.
There are three types of atrophic scars: ice pick scars, boxcar scars, and rolling scars. Ice pick scars are the most common type, accounting for 60-70% of all atrophic scarring cases. They are small and narrow, resembling deep pores or a deep, sometimes V-shaped indentation. Boxcar scars have flat bottoms and defined borders, resembling small potholes in a paved road. Rolling scars do not have distinct edges and are usually found on the cheeks.
Atrophic scars are often associated with severe acne or chickenpox. They can also occur after the removal of a mole. These scars can be challenging to treat and may require multiple procedures over an extended period. Treatment options include microneedling, chemical peels, laser therapy, punch excision, and filler injections.
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Scars can be treated with pressure therapy, surgery, or topical creams
Scars are areas of fibrous tissue that replace normal skin after an injury. They are composed of the same collagen as the tissue it has replaced, but the composition of the scar tissue is different, lacking the elasticity of normal tissue.
For those wanting to minimise the appearance of scars, there are various treatment options available, including surgery. Scar revision surgery attempts to minimise the scar so that it blends in with the surrounding skin tone and texture. The different types of scars that can be improved by surgery include discoloration, surface irregularities, acne scars, and scars from minor injuries or prior surgical incisions.
Topical treatments are also available to help reduce redness, inflammation, and itching associated with scars. Silicone sheets, creams, or gels can be used to create a seal over the skin, keeping the area hydrated and regulating collagen production. Prescription retinoids like tretinoin and tazarotene are also effective long-term topical treatments to reduce the appearance of colour changes, acne scars, and stretch marks.
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Frequently asked questions
Scars are formed as part of the healing process after the skin has been cut or damaged. The skin repairs itself by growing new tissue to fill in any gaps caused by the injury. This new tissue is called scar tissue and has a different texture and quality than the surrounding tissue. Scar tissue is made primarily of collagen, a naturally occurring protein in the body.
Scars can be categorised in several ways, depending on their shape, colour, and texture. They can be flat, lumpy, sunken, or coloured. They can also be itchy, painful or uncomfortable. Some common types of scars include:
- Contracture scars: Often developing after a burn, these scars cause the skin to tighten and may make it difficult to move.
- Depressed (atrophic) scars: These are indented scars that happen when the skin heals below the normal layer of skin due to a lack of tissue. They often result from severe acne or chickenpox.
- Keloid scars: These are raised above the skin's surface and spread beyond the wounded area. They are caused by the overproduction of collagen and can occur spontaneously or from surgery, cuts, accidents, acne, or body piercings.
- Hypertrophic scars: These are raised scars that generally form due to a disruption in scar maturation, leading to excessive connective tissue formation. They usually occur within 4 to 8 weeks following wound closure.
A mature scar is one that has completed the wound healing process. This process involves hemostasis (where blood clots to stop bleeding and form a scab), inflammation (where white blood cells fight infection and clean the wound), proliferation (where new tissue, blood vessels, and collagen fibres form to fill the wound), and finally, maturation. During maturation, collagen fibres reorganise, and the scar becomes smaller and paler. This final stage can take months or even years, and the scar will continue to fade over time.
