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Scar Tissue: Formation, Types and Treatment

Scar tissue forms after injuries or surgery as part of the natural wound healing process. It consists of connective tissue and can affect the appearance and function of the skin.

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Things worth knowing about "Scar Tissue"

Scar tissue forms after injuries or surgery as part of the natural wound healing process. It consists of connective tissue and can affect the appearance and function of the skin.

What is Scar Tissue?

Scar tissue is the result of the body´s natural healing process following an injury, surgery, or inflammation. When the skin or deeper tissue layers are damaged, the body replaces the destroyed tissue with newly formed connective tissue rich in collagen fibers. This newly formed tissue is referred to as scar tissue. It differs from the original, healthy tissue in structure, appearance, and function.

Formation of Scar Tissue

The formation of scar tissue occurs in several phases of wound healing:

Inflammatory phase: Immediately after an injury, the body initiates an inflammatory response to fight bacteria and remove dead tissue.
Proliferative phase: Specialized cells called fibroblasts migrate into the wound and produce collagen to close the tissue gap.
Remodeling phase: The newly formed collagen tissue is restructured and densified over months to years. The scar changes in appearance and texture during this time.

Types of Scar Tissue

Normal Scars

Normal scars are flat, pale, and cause no major problems. They result from uncomplicated wound healing and improve in appearance over time.

Hypertrophic Scars

Hypertrophic scars are raised and thickened but remain confined to the area of the original wound. They result from excessive collagen production and may cause itching or a feeling of tightness.

Keloids

Keloids are a special form of scarring in which scar tissue grows beyond the boundaries of the original wound. They are often painful, itchy, and tend to recur after treatment. Keloids are more common in people with darker skin tones.

Atrophic Scars

Atrophic scars lie below the normal skin surface and occur when too little collagen is produced. Common examples include acne scars and chickenpox scars.

Contracture Scars

Contracture scars often result from burns and can restrict movement, as the scar tissue pulls the skin together and impairs joint function.

Symptoms and Complaints

Scar tissue can cause various complaints, including:

Itching and burning in the scar area
A feeling of tightness and restricted mobility
Pain, particularly with keloids and hypertrophic scars
Changes in skin appearance that may cause psychological distress
Functional limitations when scars are located over joints

Diagnosis

Scar tissue is usually diagnosed through a clinical examination by a doctor or dermatologist. In special cases, a biopsy (tissue sample) may be necessary to determine the type of scar tissue or rule out other conditions. For deep scar tissue, for example after internal surgery, imaging techniques such as ultrasound or MRI may be used.

Treatment of Scar Tissue

Several treatment options are available depending on the type and severity of the scar tissue:

Conservative Treatments

Silicone patches and gels: These can flatten the scar and reduce itching.
Compression bandages: Used primarily for hypertrophic scars and keloids to inhibit growth.
Scar massage: Regular massage can improve circulation and loosen the tissue.
Corticosteroids: Intralesional corticosteroid injections can flatten scar tissue and reduce inflammation.

Medical and Aesthetic Treatments

Laser therapy: Various laser techniques can improve the appearance of scars and reduce redness.
Microneedling: Fine needles stimulate collagen production and can fill in atrophic scars.
Chemical peels: Fruit acid or trichloroacetic acid peels can smooth the scar surface.

Surgical Treatments

Scar revision: Surgical procedures may be necessary for severely disfiguring or functionally limiting scars.
Skin grafting: For extensive scars, such as those caused by burns, transplantation of healthy skin may be required.

Prevention

Optimal wound care can minimize scar formation. This includes:

Clean and moist wound coverage during the healing phase
Protecting the wound from sun exposure
Avoiding smoking, as nicotine delays wound healing
Early treatment of inflammation and infections

References

Dissemond, J. et al. - Moderne Wundversorgung, Springer Medizin Verlag, 7th Edition (2020).
Gauglitz, G.G. et al. - Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies. Molecular Medicine, 17(1-2): 113-125 (2011). PubMed PMID: 20927486.
World Health Organization (WHO) - Burns: Fact Sheet. Available at: https://www.who.int/news-room/fact-sheets/detail/burns (2018).

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