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Scars

What is a Scar?

A scar is a mark left on the skin as a result of any form of injury. The formation of a scar signals that the body is repairing the damaged portion of the skin. Scars are usually made of fibrous tissue that has collagenous white fibers. This new collagen material is created by the body to repair the wound.

Most people have at least one scar on their body. Some have scars that are barely noticeable, while some scars can be disfiguring and cause self-image issues.

Scar Signs and Symptoms

Some scars can be painful, itchy, and tender. Some may be light or dark. In extreme cases, there are scars that cause anxiety, sleep disturbances, and depression. The signs and symptoms depend on the type of scar.

  • Keloid scars. Keloids result from the excessive growth of scar tissue. These thick scars are usually characterized by fibrous tissue going beyond the original wound site.
  • Hypertrophic scars. Like keloids, these scars are thick and raised. What differentiates it from keloids is its red color. This scar is also confined to the original site of the wound. It does not go beyond the affected skin area.
  • Contracture scars. This type of scar results from burned skin. The appearance of these scars may vary depending on the severity of the burn.
  • Adhesions. Scars formed between unconnected internal organs.

Scar Causes and Risk Factors

Scars are the inevitable outcomes of the body’s natural healing process. Body tissue can be damaged owing to a number of causes.

  • Accidental injury. This includes tissue damage after falling off a bike, tripping, slipping, and a host of other accidents.
  • Burns. Examples of these are skin injuries from exposure to fire, radiation, friction, chemicals, and electricity.
  • Bites. Animal bites usually leave unsightly scars on the skin. The type of scar depends on the severity of the bite and the kind of animal that caused the injury.
  • Scratches. Scratching an insect bite or an itchy area of the body may sometimes cause scarring.
  • Punctures. Puncture wounds from needles, nails, and other pointed objects leave scars.
  • Infections. Fungal skin infections may lead to scar formation especially if they are not treated properly and if they are constantly scratched.

Diagnosing Scars

Dermatologists usually conduct a physical exam to determine the type of scar. The key elements they look at are the size of the scar, its texture, elevation, and location. The scar will also be evaluated based on the cause of scarring and the patient’s medical history.

Treatment Options for Scars

Contrary to what some treatment centers or topical cream endorsers claim, a scar cannot be completely removed. It can only be minimized or made less visible. Healthcare providers will determine the best possible treatment based on the type and severity of the scar, as well as the patient’s age and medical history.

Surgical, Chemical, and Laser Procedures

  • Dermabrasion. This involves an exfoliation technique to remove the top layer of the skin. The goal of this kind of treatment is to rejuvenate the skin in hopes of making the scar less visible.
  • Collagen injection. Collagen gel is injected into a depressed acne scar to make the skin look plump, lessening the visibility of the scar.
  • Chemical peel. This procedure entails the use of a chemical solution like alpha hydroxy acid to lighten the appearance of mild scarring.
  • Cryosurgery. Cryogens are used to freeze surface skin lesions. However, a major concern regarding this type of treatment is secondary wound infection.
  • Scar revision surgery. This is an invasive procedure that makes a scar less visible.
  • Laser resurfacing. This cosmetic procedure makes use of laser to improve the appearance of scarred skin.
  • Punch graft. This is an invasive procedure used to treat deep scars. Dermatologists use a small equipment to make a small hole in the skin, remove the scar, and plug the hole with new skin. This a relatively costly procedure.

Oral and Topical Treatments (Prescription and Over the Counter)

Consumers have a wide variety of options for both over-the-counter and prescription ointments, gels, and creams that can reduce scars.

  • Oral
    • Antibiotics. Oral antibiotics like tetracyclines are used to treat acne scars.
    • Calcium channel blockers. Medications like verapamil are used to reduce scar formation by preventing fibroblast adhesion and proliferation.
    • Antihistamines. Diphenhydramine hydrochloride is used to reduce keloid scars.
  • Topical
    • Corticosteroids. Topical corticosteroids like hydrocortisone help reduce the redness, swelling, and itchiness of a scar. This is usually prescribed for scars caused by dermatitis and insect bites.  
    • Silicone sheets and gels. Silicone treatment sheets are considered as a low-cost and efficient means of treating keloid scars. It helps diminish scars and restores skin close to its natural color and texture.
    • Retinoid-like agents. Retinol, also known as Vitamin A1, is known to reduce scarring caused by acne. Retinol cream is popular for its anti-aging effect.
    • Vitamin E. Creams that contain Vitamin E are usually recommended to lessen skin inflammation. Vitamin E is known for its antioxidant properties.
    • Immunomodulators. These are substances that help regulate the immune system. Topical immunomodulators are used as therapy for keloids.

Home Remedies

  • Honey. Raw honey helps lighten the appearance of scars.
  • Aloe vera. The juice from this succulent is a popular traditional remedy for acne and acne scars.
  • Coconut oil. Vitamin E in coconut oil promotes the healing of damaged skin.
  • Olive oil. Extra virgin olive oil is massaged on the skin to promote the healing of damaged areas.
  • Lemon. Juice from this citrus fruit removes dead skin cells and facilitates the regeneration of new skin cells.

References

Bayat A, McGrouther DA, Ferguson MWJ. Skin scarring. BMJ Publishing Group. 11 January 2003; 326 (7380): 88-92.

University of Western Ontario. “When Healing Turns To Scarring: Research Reveals Why It Happens And How To Stop It.” ScienceDaily. ScienceDaily, 24 September 2008. <www.sciencedaily.com/releases/2008/09/080918192824.htm>.   

American Society for Dermatologic Surgery, https://www.asds.net/Scars/

Rhett JM, Ghatnekar GS, Palatinus JA, O’Quinn M, Yost MJ, and Gourdie RG. Novel therapies for scar reduction and regenerative healing of skin wounds. Trends Biotechnol. 2008 Apr;26(4):173-80. doi: 10.1016/j.tibtech.2007.12.007. Epub 2008 Mar 4.

Tornambe, Robert. “Why do we scar?” The Huffington Post, 25 May 2011. <http://www.huffingtonpost.com/robert-tornambe-md/scar-treatment-_b_830479.html>

Lee, Michael and Marks, Robin. “The role of corticosteroids in dermatology.” 1998;21:9-111 Jan 1998DOI: 10.18773/austprescr.1998.010 <https://www.nps.org.au/australian-prescriber/articles/the-role-of-corticosteroids-in-dermatology>

Sakuraba, M., Takahashi, N., Akahoshi, T. et al. Gen Thorac Cardiovasc Surg (2010) 58: 467. doi:10.1007/s11748-010-0605-z

Achao Han, et. Al. Verapamil inhibits scar formation after peripheral nerve repair in vivo. Neural Regen Res. 2016 Mar; 11(3): 508–511.

Viera, Martha, et al. Innovative therapies in the treatment of keloids and hypertrophic scars. J Clin Aesthet Dermatol. 2010 May; 3(5): 20–26.

Johns Hopkins  Medicine http://www.hopkinsmedicine.org/healthlibrary/conditions/dermatology/scars_85,P00313/