Scarring: Types, Treatments, and Causes

Scarring can be a frustrating and disheartening experience for anyone, but have you ever wondered why some scars fade quickly, while others remain stubbornly visible? The answer lies in the body’s fascinating healing process, the type of scar, and various factors that can influence their appearance. Delve into the world of scars and learn how to better manage and even improve their appearance with the right treatments, preventative measures, and home care techniques.

Key Takeaways

• Understanding scars involves being aware of the body’s natural healing process and potential treatments.
• Factors such as age, genetics, skin type, location of injury and treatment type can affect scarring.
• Scar treatment options include laser therapy, microneedling, steroid injections or surgical revision. Preventative measures such as wound care and sun protection may also be used in conjunction with over-the counter products for optimal results.

Understanding Scars

Scars, whether from acne, surgery, or an injury, are a natural part of the body’s healing process.The formation of scar tissue is the body’s way of repairing damaged skin, creating a protective barrier over the wound. However, not all scars are created equal – some may fade over time, while others can become raised or sunken, presenting a more noticeable appearance. As the healing process continues, scars fade, becoming less prominent and noticeable.
Understanding the influences that can affect scarring, including burn scars, and the array of treatments on offer can aid in managing these undesirable skin marks.

The Healing Process

When your skin experiences an injury, your body’s healing process kicks into high gear.The wound healing process is a complex series of events involving various cells, including fibroblasts, which are responsible for laying down collagen and playing a crucial role in the formation of scar tissue. As the wound heals, collagen fibers are produced to replace the damaged skin, but unlike normal skin, scar tissue lacks hair follicles, sebaceous glands, and even sweat glands. This results in a visible difference between the scar and the surrounding skin.
Adult wound healing typically follows three main phases:

1. Inflammation: During this phase, blood vessels constrict to minimise blood loss, and immune cells are sent to the wound site to ward off infection.
2. Proliferation: New tissue begins to form during this phase, with collagen playing a significant role in providing structure and strength.
3. Remodeling: The remodeling phase involves the reorganisation of collagen fibers to form a more organised structure, ultimately resulting in a mature scar.

Although the body’s healing process is amazing, it’s not always flawless. The formation of scar tissue can be influenced by various factors, such as the depth and size of the injury, genetics, overall health, and gender or ethnicity. These factors can determine whether a scar will be flat, raised, or sunken, and how noticeable it will be. Understanding the factors that contribute to scar tissue formation can help in managing the healing process more effectively.

Factors Affecting Scarring

The severity and appearance of scars can be influenced by several factors. Some factors include:

• Age: Younger individuals tend to heal faster and have less noticeable scars.
• Genetics: Some people are more prone to developing keloid scars, which are raised and thickened scars resulting from excessive collagen production.
• Skin type: Higher melanin levels and either African or Asian ancestry can potentially contribute to the visibility of adverse scarring.

Location of the injury is another factor that can affect the appearance of scars. Hypertrophic scars, which are similar to keloid scars but do not extend beyond the boundaries of the original injury, are more likely to form following infection of the wound, closure of the wound with excessive tension, or when the wound is located in areas of skin with high natural tension (such as the shoulders, neck, and sternum). Atrophic scars, on the other hand, are depressions in the skin with a pitted appearance and are commonly attributed to acne or surgery.
Comprehending these influences can aid in guiding the suitable scar treatment, as diverse scar types may respond more effectively to specific treatments. For example, keloid and hypertrophic scars may benefit more from steroid injections, while atrophic scars may respond better to filler injections or laser therapy.

Types of Scars

There are several types of scars, each with their unique characteristics and causes. Knowing the distinctions between these scar types is crucial to efficiently treat and manage them. The main types of scars include:

1. Keloid scars
2. Hypertrophic scars
3. Atrophic scars
4. Contracture scars

Keloid and hypertrophic scars are both examples of pathological scar formations, meaning they’re more severe and can have a significant impact on a person’s overall wellbeing. Keloid scars are particularly troublesome as they can grow indefinitely into large, tumorous neoplasms. Hypertrophic scars, while not as severe as keloids, are still raised and thickened due to excessive collagen production during the healing process.
On the other hand, atrophic and contracture scars result from a loss of underlying skin structures. Atrophic scars are depressed or sunken, often caused by acne or surgery. Contracture scars, usually resulting from burns, occur when the skin contracts and tightens, creating a tight, shiny scar.

Keloid Scars

Keloid scars are a more serious type of scarring which can become large tumours. They have the potential to continuously grow, making them a much more complex condition than other forms of scarring. These scars have the following characteristics:

• They extend beyond the original injury site
• They can become large and raised
• They can cause pruritus (itching) and hyperesthesia (increased sensitivity to touch)

Treating keloid scars can be challenging due to their unique characteristics.
Keloid scars can affect anyone, but they are more prevalent among individuals with dark skin tones. A keloid scar can be caused by a variety of skin injuries, including:

• cuts
• burns
• acne
• surgery
• body piercings
• tattoos

Their formation is believed to be due to an irregular type I and III collagen production.
Because keloid scars can be difficult to treat, specialised approaches may be necessary. Some treatment options include steroid injections, radiation therapy, and surgical excision followed by skin grafts or reconstructive surgery. It’s critical to share any predisposition to keloid scarring or family history of keloid scarring with a dermal technician. Such information will enable the technician to determine the recommended treatment options.

Hypertrophic Scars

A hypertrophic scar is a type of raised and thickened scar resulting from an excessive production of collagen during the healing process. They differ from keloid scars in that they do not extend beyond the boundaries of the original injury. Hypertrophic scars are predominantly composed of type III collagen fibers arranged in a parallel orientation to the skin surface.
Light-skinned people often have red, raised lumps as a result of scarring. Darker skinned individuals may observe darker brown lumps on their skin. Hypertrophic scars are commonly caused by wound infection, wound closure with excess tension, and other traumatic skin injuries.
Treatment options for hypertrophic scars include steroid injections, laser therapy, and surgical revision. The choice of treatment depends on the severity and location of the scar, as well as the individual’s aesthetic goals and preferences.

Atrophic Scars

Atrophic scars, also known as sunken scars, appear to be sunken or indented in the skin. They form underneath the normal layer of skin tissue and cause after healing of a wound. These scars occur when the skin does not produce an adequate amount of collagen during the healing process, resulting in a loss of underlying skin structures.
Atrophic scars, often resulting from severe acne or surgery, can be challenging to treat, as they often require a combination of treatments to improve their appearance. Some treatment options for atrophic scars include:

• Subcision
• Laser therapy
• Microneedling
• Steroid injections
• Surgical revision

To prevent atrophic scars, one should practice proper wound care, use sun protection, utilise over-the-counter treatments, and apply silicone-based products for scars.

Contracture Scars

Contracture scars are a type of scarring that occurs when a considerable area of skin is damaged and lost, typically as a result of burns. The scarring causes the edges of the skin to be drawn together, resulting in a tight area of skin that may limit mobility due to the contracture scar.
The typical causes of contracture scars include trauma, burns, surgery, infections, and inflammation of tissue. The indications of contracture scars may comprise of itching, pain, tightness, difficulty in movement, and alterations in color and texture of the skin. In extreme cases, contracture scars can cause functional issues and aesthetic abnormalities.
Treatment options for contracture scars may include surgical intervention, such as skin grafts or reconstructive surgery, to improve the appearance and functionality of the scar. Consulting a medical professional to ascertain the optimal course of action for treating contracture scars, based on the individual’s specific needs, is vital.

Possible Scar Treatment Options

Various treatments are available to reduce scarring and improve the appearance of scars, including:

• Laser therapy
• Microneedling
• Steroid injections
• Surgical revision

The choice of treatment depends on the type of scar, its location, and the individual’s aesthetic goals.
Consulting a medical professional to identify the best treatment option for your specific scar type and situation is vital. Keep in mind that while these treatments can help improve the appearance of scars, they may not completely remove them.
In some cases, a combination of treatments may be necessary to achieve the desired results. Being patient and persistent with scar treatments is key, as the healing process can be lengthy, and enhancements may not be instantly noticeable.

Laser Therapy

Laser therapy is a popular treatment option for various types of scars, utilising different wavelengths of light to enhance their appearance. There are two primary types of lasers used in scar treatment: ablative and non-ablative.
Ablative lasers work by removing the outer layers of skin, which can stimulate collagen production and encourage the growth of new, healthy skin cells. Non-ablative lasers, on the other hand, do not remove the skin’s surface but instead penetrate the skin to stimulate collagen production.
Choosing between ablative and non-ablative lasers hinges on the scar’s severity, skin type, and desired results. Consulting a medical professional to identify the most fitting type of laser therapy for your specific scar and situation is crucial.

Microneedling

Microneedling is a minimally invasive treatment that stimulates collagen production to improve the appearance of scars, acne, and other skin issues. The process involves the use of tiny needles to create controlled micro-injuries in the skin, which in turn stimulates the production of collagen and elastin to repair and rejuvenate the skin.
Microneedling can be administered by a dermatologist or skin care specialist and is generally well-tolerated by patients. It is deemed an effective and cost-effective method for treating various types of scars, including acne scars and post-surgical scars.
The cost of microneedling treatments for scars may range from $50 to $400, depending on the severity of the scars and the area being treated. Consulting a medical professional to ascertain the most appropriate microneedling treatment for your particular scar type and situation is key.

Steroid Injections

Steroid injections can help reduce the appearance of keloid or hypertrophic scars by decreasing inflammation and collagen production. These injections are administered directly into the scar tissue, helping to flatten and soften the scar’s appearance over time.
The effectiveness of steroid injections for scar treatment can vary, with some patients reporting significant improvement in the appearance of their scars, while others may experience minimal changes. In some cases, other injection treatments, such as interferon, fluorouracil, and bleomycin, may be used in conjunction with steroid injections to improve treatment outcomes.
Consulting a medical professional to identify the best steroid injection treatment for your specific scar type and situation, along with discussing the potential risks and side effects associated with this treatment option, is crucial.

Surgical Scar Revision

In some cases, surgical intervention may be necessary to improve the appearance and functionality of a scar. Surgical revision involves:

• Anesthesia
• Treatment of the scar tissue with methods like excision, dermabrasion, laser resurfacing, or Z-plasty
• Stretching healthy skin to cover the wound

The precise approach is contingent upon the type and severity of the scar, as well as the individual’s aesthetic goals and preferences.
Surgical revision, such as scar revision surgery, can be effective in making scars less noticeable and more acceptable, focusing on improving the cosmetic appearance of the scar and potentially having a positive emotional impact. However, it should be noted that surgical revision does not completely remove the scar.
The potential risks and complications associated with surgical revision for scars may include:

• Bleeding from the surgical site
• Postoperative infection
• Suboptimal scarring, including the possibility of keloid formation
• Loss of sensation
• The potential requirement of revision surgery

It is essential to consult with a medical professional to determine the best course of action for treating scars through surgical revision based on the individual’s specific needs and preferences.

Preventative Measures and Home Care

Proper wound care, sun protection, and over-the-counter treatments can help minimise scarring and improve the appearance of existing scars. These preventative measures and home care techniques can not only reduce the risk of developing new scars but also help manage and improve the look of those already present.
Implementing these measures allows you to control your skin’s healing process, possibly averting the need for more invasive scar treatments. Consistency in your efforts and patience for these measures to work is crucial, as the results may not be instantly discernible.
This section explores practical advice and suggestions to incorporate proper wound care, sun protection, and over-the-counter treatments into your daily routine.

Wound Care

Ensuring proper wound care is crucial to lessen the risk of scarring and foster the body’s healing process. Keeping the wound clean, moist, and covered can help prevent infection and minimise scarring. Additionally, it’s crucial to avoid picking at scabs, as this can interfere with the healing process and result in more noticeable scars.
The use of appropriate dressings, such as moist dressings, silicone gels, or sheets, and ointments or hydrogels, can facilitate wound care and promote a more favorable healing environment. Special dressings like the embrace device can help reduce scar formation. These dressings are designed to offload mechanical tension and have been shown to be effective in some cases..
It’s important to carefully follow your healthcare provider’s instructions for wound care and to monitor the healing process closely. If you notice any signs of infection or other complications, consult your healthcare provider immediately.

Sun Protection

Shielding scars from sun exposure is vital to avert their darkening and degradation in appearance. UVA and UVB radiation can have detrimental effects on scars, impeding wound healing and adversely affecting the cosmetic appearance of scars.
For effective protection of scars from the sun, it’s crucial to use a high-quality sunscreen with an SPF of 30 or higher and broad-spectrum protection. Mineral sunscreens, also known as physical sunscreens, are particularly effective for protecting scars, as they contain active ingredients such as zinc oxide or titanium dioxide, which provide maximum UV protection while being gentle on sensitive skin and scar tissue.
In addition to sunscreen, other sun protection measures, such as wearing clothing with UPF (Ultraviolet Protection Factor) and seeking shade when outdoors, can help ensure that your scars are adequately protected from the sun’s harmful rays.

Over-the-Counter Treatments for Scars

Various over-the-counter treatments are available to help reduce scar formation and improve the appearance of existing scars. Some options include:

• Genova Scar Gel (a topical gel that helps to soften and smooth scars while promoting skin healing)
• Mederma Skin Care gel (an onion extract-based product)
• Imiquimod cream (a pharmaceutical agent that modulates the inflammatory response in wound healing and stimulates interferon activity)

Although the effectiveness of these treatments may differ, they provide a more accessible and cost-effective option for individuals aiming to enhance the appearance of their scars. Carefully reading product labels and following recommended usage instructions is crucial for optimal results.
When selecting an over-the-counter treatment for scars, it’s important to consider the type of scar, the severity of the scar, and any potential sensitivities or allergies to the product’s ingredients. If you’re unsure of which treatment is best for you, consult with a healthcare professional for guidance.

Silicone based products for scars

Silicone treatments, such as gels and sheets, can help prevent and improve the appearance of scars, although evidence of their effectiveness is limited. These products work by creating a moist and protective barrier over the scar, which can promote optimal healing conditions and minimise the risk of excessive scar formation. Genova Scar Gel is an over-the-counter treatment option that is designed to help reduce the appearance of scars. This topical gel works by softening and smoothing the scar tissue, while promoting skin healing. It is a non-invasive and cost-effective solution that can be used at home to manage and improve the appearance of scars. The gel is easy to apply and can be used on both new and old scars
Several studies have demonstrated that silicone gel sheets can boost the hydration of the stratum corneum, the skin’s outermost layer, contributing to their potential benefits for scar prevention and enhancement. The embrace device, a novel adhesive silicone sheet that is applied to a healing wound and continuously releases tension, has also been reported to significantly improve the appearance of treated scars compared to control scars after 12 months.
To use silicone-based products for scar prevention and improvement, follow these steps:

1. Read and follow the manufacturer’s instructions for application and wear time.
2. Be patient and consistent with these treatments, as results may not be immediately apparent.
3. Use the product for several weeks or months to see the best results.

Summary

Scarring is a natural part of our body’s healing process, but various factors can affect the appearance and severity of scars. Understanding the different types of scars, their causes, and the available treatment options can help you make informed decisions about managing and improving your scars. By incorporating proper wound care, sun protection, and over-the-counter treatments into your daily routine, you can take control of your skin’s healing process and potentially prevent the need for more invasive scar treatments. Remember, patience and persistence are key – with the right approach, you can embrace your journey towards healthier, more beautiful skin.

FAQs

What causes scarring?

Scars form when the skin is damaged and collagen fibers are produced to repair the injury. They may occur as a result of infections, surgery, injuries, or inflammation of tissue, appearing in different shapes and sizes with varying composition.

What is the term for scarring?

The term 'Cicatrix', also known as a scar, refers to the mark that remains on the skin after the healing of injured tissue.

Can scarring be healed?

Scars cannot be completely healed, however they can be improved and fade over time. Depending on the type of injury or wound, this process can take up to 2 years or more. Your healthcare provider can advise you on activity restrictions during the healing process.

What happens during scarring?

Scarring is the body's natural response to healing a wound, where collagen proteins are used to bridge the gap and seal off the injury. This process results in scar tissue that is thicker and less elastic than the surrounding skin, potentially leading to tightness, limited movement and pain. Scarring may appear in many shapes and sizes depending on the extent of the injury.

What are the 3 main types of scars?

The three main types of scars are Keloid scars, Hypertrophic scars and Contracture scars. Keloid scars are thick, raised clusters of scar tissue that can grow beyond the edges of a wound. Hypertrophic scars are similar to keloids but remain within the boundaries of a wound. Lastly, Contracture scars occur when the healing skin pulls the scar downwards, causing it to appear sunken or pitted.