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Scars: Causes, Types and Treatment

Scars are permanent areas of fibrous tissue that replace normal skin after an injury heals. They can vary greatly in appearance and severity.

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Things worth knowing about "Scars"

Scars are permanent areas of fibrous tissue that replace normal skin after an injury heals. They can vary greatly in appearance and severity.

What Are Scars?

A scar (medical term: cicatrix) is the natural result of the body's wound healing process. Whenever deeper layers of the skin are damaged by injuries, surgery, burns, or skin conditions such as acne, the body produces new connective tissue to repair the damage. This newly formed tissue differs in structure and appearance from the original skin and becomes visible as a scar.

Causes of Scarring

Scars can form as a result of various causes, including:

Injuries: Cuts, abrasions, and lacerations
Surgery: Surgical incisions leave behind surgical scars
Burns: Thermal or chemical burns
Acne: Inflammatory skin conditions can leave permanent marks
Infections: Deep skin infections affecting lower skin layers
Diseases: Conditions such as chickenpox that affect the skin

Types of Scars

There are several types of scars, each differing in appearance and texture:

Normotrophic Scar

A normotrophic scar is flat, pale, and flush with the surrounding skin. It is considered the ideal healing outcome.

Hypertrophic Scar

A hypertrophic scar is raised, reddish, and remains confined to the original wound area. It results from excessive collagen production during healing.

Keloid

Keloids are raised, overgrown scars that extend beyond the original wound boundaries. They may itch or be painful and tend to recur after treatment. People with darker skin tones are more frequently affected.

Atrophic Scar

Atrophic scars sit below the skin surface and form due to loss of underlying tissue, for example after acne or chickenpox.

Contracture Scar

Contracture scars often develop after burns and can restrict movement when they form over joints.

Symptoms and Complaints

Scars can be associated with various symptoms:

Itching, especially during the healing phase
A feeling of tightness in the scar area
Pain, particularly with keloids and hypertrophic scars
Restricted movement with contracture scars
Aesthetic concerns and psychological distress

Diagnosis

Scars are usually diagnosed through a clinical examination by a physician or dermatologist. In cases of unusual or changing scars, a skin biopsy may be necessary to rule out other conditions. Imaging techniques may be used when deeper tissue damage is suspected.

Treatment of Scars

There are many options for treating scars or improving their appearance:

Conservative Treatment

Silicone products: Silicone sheets or gels can flatten and lighten hypertrophic scars and keloids
Scar massage: Regular massage improves circulation and loosens adhesions
Compression therapy: Pressure garments are commonly used after burns
Corticosteroid injections: Reduce inflammation and flatten raised scars

Medical and Surgical Procedures

Laser treatment: Can remove scar tissue and improve skin texture
Dermabrasion: Mechanical resurfacing of the scar surface
Microneedling: Stimulates collagen production for smoother skin
Surgical scar revision: Operative removal or reshaping of the scar
Filler injections: Atrophic scars can be filled with hyaluronic acid

Prevention

Proper wound care from the beginning is essential for minimizing scarring. This includes carefully cleaning and covering wounds, avoiding scratching during healing, and consistently applying UV protection to scar areas.

References

Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003;326(7380):88-92.
Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG. Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med. 2011;17(1-2):113-125.
World Health Organization (WHO): Burn prevention: success stories and lessons learned. Geneva: WHO Press, 2011.

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