• Scars—Overview

    Definition

    A scar is skin that forms over a wound as the skin heals. There are four main types of scars:
    • Keloid—thick scars that grow out from the skin. They spread beyond the site of the wound.
    • Contracture—often the result of a burn injury. The scar appears as a tightening of the skin. This type may also affect muscles and nerves below the skin.
    • Hypertrophic—thick, raised scars. They look like keloid scars but do not spread beyond the site of the wound.
    • Atrophic—thinned out, cigarette paper-like scars
    • Acne—may look like deep pits or be angular and wavelike.
    Scars do not go away on their own but may fade over time. Some people may feel self-conscious about their scars. This can affect their quality-of-life. Other scars may also cause physical difficulties. For example a scar on the face may affect movement of eyelids.

    Causes

    A scar is part of the normal healing process. The scar is made of the same material as the surrounding skin but it is made a little differently. As a result, the scar tissue appears different than the surrounding skin.
    The size and appearance of a scar will vary based on:
    • Type of injury
    • How your skin scars—some people scar more easily than others
    • Where the injury occurred
    • How long it took for your skin to heal
    • Age, heredity, gender, and ethnicity

    Risk Factors

    Factors that may increase your chance of a scar include:
    • Injury to skin, such as a cut, scrape, puncture, or burns
    • Surgery
    • Infections
    • Acne
    Normal Surgical Scar
    Post-operative scar
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    Signs and Symptoms

    A scar may first look red and thick. It may may feel numb, itchy, painful, or sensitive. Overtime, the scar may fade. Then it may be raised, flat, depressed, dark, or light in color. The seriousness of the wound will affect how noticeable the scar is.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may be referred to a skin specialist.

    Treatment

    Most scars will fade over time, although they rarely go away completely. Some types of scars do not fade at all.
    There are many treatments that can improve the appearance of a scar. Talk with your doctor about the best treatment plan for you:

    Creams, Ointments, and Gels

    Over-the-counter and prescription products can be used for scars caused by surgery or injury. Some examples include:
    • Corticosteroids—can also decrease itching
    • Silicone-containing patches, gels or creams

    Dermabrasion

    Dermabrasion uses a special tool to remove a layer of the scar tissue. It can make the skin appear smoother.
    This treatment may be used for minor problems on the skin's surface. This may include acne scars or surgical scars.

    Chemical Peel

    A chemical peel uses specific chemicals to remove the top layer of skin. It can create a smoother appearance and even color.
    This treatment is best for treating scars that are not deep or small acne scars.

    Cryotherapy

    Cryotherapy is freezes the scar tissue with liquid nitrogen. The scar tissue will then blister and fall off.
    Cryotherapy may be used to treat protruding scars, like keloids.

    Injections

    Steroid injections into the scar may shrink scar tissue. It may be used for scars that stick out, like keloid and hypertrophic scars.

    Tissue Fillers

    The appearance of soft, indented scars, may be reduced by injecting fillers. The filler may make them appear more even. Fillers used include:
    • Collagen
    • Hyaluronic acid
    • Fat
    • Silicone
    This effect is not permanent. Filler injections often need to be repeated.

    Pressure Bandages

    Pressure bandages may be applied around the scar. The pressure may help to flatten the scar.

    Surgery

    Surgery can improve the appearance of some scars. It may help to change the scar's size, location, color, or depth. However, surgery may not be able to erase the scar completely.
    Some surgical options include:
    Surgical Scar Revision
    The scar is cut out. The area is then closed in a way that leaves a new, less noticeable scar.
    Skin Graft
    A skin graft surgery is removes healthy skin from one part of the body and moves it to another area. A skin graft may be taken from the inner thigh, buttocks, near the collar bone, in front of or behind the ear, and the upper arm.
    Punch Graft and Excision
    A depressed scar is punched out from the skin, much like a cookie cutter. The punched out tissue is then placed back but is lifted up to match the surrounding skin.
    In a punch excision, the tissue is not placed back in. Once the scar is removed, the wound is closed with stitches. This treatment works best for deep or pitted acne scars.
    Laser Surgery
    There are several different types of lasers that may be used. They type of laser will depend on your scar. Lasers may help to lighten pinkish-purple scars and/or flatten red scars.

    Prevention

    If you have a wound, follow your doctor’s wound care instructions. Proper care may reduce the appearance of a scar. To help minimize scarring, take the following steps:
    To minimize scarring from acne:
    • Work with your doctor to create a plan to properly treat and care for your skin.
    • Avoid the temptation to pick or pop an acne pimple, since this can cause scarring and infection.
    • Protect your skin from the sun.
    To minimize contracture scarring (after injuries like burns):
    • Wear pressure garments. Pressure garments are tight-fitting clothes that are worn over a burn. These garments can reduce scarring.
    • Wear a splint will keep a joint straight.
    • Practice range of motion exercises to keep muscles and joints flexible.
    • Keep active. This will keep the scar stretched and prevent it from tightening.
    If you are prone to keloid scars, pressure treatment and silicone gel sheeting may help prevent them.

    RESOURCES

    The American Academy of Dermatology http://www.aad.org

    American Osteopathic College of Dermatology http://www.aocd.org

    CANADIAN RESOURCES

    Canadian Dermatology Association http://www.dermatology.ca

    Healthy Canadians http://www.healthycanadians.gc.ca/index-eng.php

    References

    Acne. Nemours Teen Health website. Available at: http://kidshealth.org/teen/your%5Fbody/take%5Fcare/skin%5Ftips.html. Updated February 2011. Accessed February 21, 2013.

    Hypertrophic scar. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated December 1, 2011. Accessed February 21, 2013.

    Keloid. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated June 7, 2010. Accessed February 21, 2013.

    Preventing scars and contractures. Children’s Hospital of the King’s Daughters website. Available at: http://www.chkd.org/healthlibrary/content.aspx?pageid=P01754. Updated June 10, 2011. Accessed February 21, 2013.

    Scars. National Health Services website. Available at: http://www.nhs.uk/Conditions/Scars/Pages/Introduction.aspx. Accessed March 5, 2013.

    Surgery of facial scars. Facial Plastic Surgery website. Available at: http://www.aafprs.org/patient/procedures/facial%5Fscar.html. Accessed February 21, 2013.

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