Scars
Introduction
A scar is a fibrous tissue replacing normal tissues destroyed by injury or disease.
- Scar formation is natural in the healing process of wounds.
- The more the skin is damaged, the longer it takes for the damage to heal and the greater chance of developing a noticeable scar.
Signs
Most scar may initially appear redder and thicker, which then rapidly fade.
- A scar may fade so much that you can barely see it, but it never completely disappears.
A scar's appearance depends on several factors, such as
- Injury or event that caused the scar
- Depth, size and location of the wound
- The patient's age, gender, ethnicity and heredity.
- Treatment received
Types of Scars
Atrophic (depressed)
- It may appear sunken or pitted. This happens because the inflammation in the skin destroys collagen as the wound heals.
- May result from acne or chickenpox.
- Sunken scars can become more noticeable as you age.
Contracture
- Commonly caused by burns.
- This occurs when the skin shrinks, leading to tightness and restriction in movement.
Hypertrophic (raised)
- Results from the overproduction of collagen in the healing wounds.
- These raised scars may get smaller over time (can take months or years), but they never completely flatten out.
- Unlike keloids, the scar remains confined to the original wound.
Keloid
- A keloid may appear months or even a year after a skin injury.
- The raised scar extends beyond the original injury site.
- As a keloid grows, it may feel painful or itchy. It may also hinder the ability to move if it forms over a joint.
- These do not go away without treatment.
Normal (flat)
- The scar gradually fades and flattens over time.
- In time, many flat scars are nearly the same colour as your skin, but may also be paler or slightly darker than surrounding skin (leaving a visible mark).
- Develops when skin stretches or shrinks quickly, e.g. during pregnancy, gaining or losing a lot of weight.
Widened
- Appears when surgical wounds are stretched as a result of skin tension during the healing process.
Treatment
Not every scar requires treatment.
- If needed, several treatments can make scars smaller or less noticeable, but treatments vary depending on the type of scar, its location, what caused it and how long you have had it.
Dermabrasion
- Removes the top layer of skin by gently "sanding" the skin.
- Commonly used in acne scar.
Laser and other light treatments
- Becoming the go-to treatment for all types of scars.
Intralesional corticosteroid injections
- Widely used to treat raised scars and keloids.
- Ease symptoms of itch and pain.
Silicone gel (sheet or ointment)
- A topical method for treatment of keloid and hypertrophic scars.
- Should be applied after wound is completely healed and closed.
- Skin graft - transplant skin from another area.
Cryosurgery
- Process of freezing keloids using liquid nitrogen.
- It may flatten the keloid but often darkens the treatment site.
Radiation therapy
- Not used often, mainly for scars resistant to other treatments.
- Concern that it can cause cancer years later.
Prevention
With the right wound care, it is possible to minimize scarring.
Stitches
- Hold the skin together while it heals
Pressure therapy
- An elastic bandage, dressing or stocking puts pressure on a wound during the healing process. The pressure prevents a scar from forming or decreases its size.
- Some patients find the pressure dressing uncomfortable and stop wearing it too soon.
Clean the wound with soap and water.
- Never use hydrogen peroxide which can cause further damage.
- Change the bandage daily after cleaning.
Keep the wound moist to prevent development of scab.
- Apply petroleum jelly or a similar ointment.
- May be helpful to use hydrogel or silicone gel sheets for large scrapes, sores, burns or persistent redness.
Protect from sunlight as sun exposure can make a scar darker.
- Apply a broad-spectrum sunscreen with an SPF or 30 or higher to the wound after it has healed.
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