In this article:
- Improper wound healing can result in the formation of thick scars, often causing other symptoms as well.
- Some individuals may develop keloids that are enlarged, thick, and itchy due to genetic predisposition.
- Properly treating minor cuts and scrapes can help minimize scar formation.
- Scars can be reduced by taking appropriate self-care measures.
Scars refer to visible marks on the skin that appear upon the healing of an injury or wound. Scar formation is part of the natural healing process.
The scars start as reddish to pink in color and fade with time, turning into a color darker or lighter than your skin. While they do become paler with time, they do not fade completely.
Scar tissue is typically formed through an increased amount of normal collagen, a rough fibrous protein produced by the body during wound healing.
The scar may be lumpy, flat, colored, or sunken. Some scars produce itchiness, whereas other scars do not manifest additional symptoms.
The type of scar depends on the injury, location of the scar, skin type, age of the person, their nutritional status, and many other factors.
Scars are quite common. Approximately 100 million patients develop scars in a year in developed countries. Most of these scars caused complications, requiring 55 million elective operations and 25 million post-trauma operations.
The most common causes of scar formation include surgery, infections, and injury. Preventing wounds can avoid scar formation.
Using protective gear, such as helmets and knee pads, during sports activities such as skating and riding a bicycle can help prevent injuries.
Multiple treatment options are available for reducing scars. Lasers are a commonly elected method for treating scars. A variety of lasers can help smoothen, discolor, or flatten scars, depending on the underlying cause.
Types of Scars
Scars may develop anywhere on the body and can vary largely depending on their composition. They have different types, including:
1. Keloid scars
Excessive collagen production at the site of injury can lead to an overgrowth of tissue known as keloid scars. Such scars continue to grow even after the completion of wound healing. These scars are raised above the skin level.
Keloid scars are initially purple or red and gradually become pale over time. These scars are generally itchy and painful. They may restrict movement if they are near a joint and are tight.
2. Contracture scars
Contracture scars are generally formed due to an injury that causes significant tissue loss, such as burns. The skin and underlying tissue pull together for healing, often restricting movement.
Injury to the joints, such as the knees, elbows, neck, or fingers, can also cause contractures, which may lead to difficulty in movement.
3. Hypertrophic scars
Hypertrophic scars appear on the wound site in raised, thick clusters. Generally, they are uncomfortable and red, often widening with time.
Hypertrophic scars may either be lighter (hypopigmented) or darker (hyperpigmented) than your skin.
4. Atrophic scars
Atrophic scars develop below the skin surface, producing a sunken appearance. Facial atrophic scars are highly pitted. These scars become more prominent with time due to the sagging and relaxation of the skin caused by aging.
The most common causes of atrophic scars are chickenpox and severe acne.
5. Stretch marks
Striae, or stretch marks, are formed due to breaks in the connective tissue.
Rapid shrinking or growing of the skin can affect the tissue that gives the skin its shape. This is generally caused by rapid weight loss, adolescence, or pregnancy. Weightlifters or bodybuilders who gain mass quickly may also develop stretch marks.
Adhesions are scars that can develop between unjointed internal organs. They often create problems during surgery.
7. Acne scars
Pimples or acne occur when the skin pores get clogged up with dead skin cells and oil. This enables bacterial growth, creating red pus-filled bumps. Improper healing of these pimples can result in scar formation.
The appearance of your scar depends on multiple factors, such as:
- Wound size and depth
- Healing time
- Age of patient
- An inherited tendency to scar
What Causes Scars
Scars are primarily the result of the natural healing process. The body produces collagen to help repair the broken tissues caused by an injury or wound.
Collagen tissues are white tough protein fibers that reconnect damaged tissues. During healing, a temporary dry crust, known as a scab, forms over the wound.
This scab plays a primary role in protecting the injured tissue. After the healing process is complete, the scab dries and falls off, revealing repaired skin and often a scar.
However, other conditions can also cause scarring, such as:
- Epidermolysis bullosa: It is a skin disease that increases the sensitivity of the skin, predisposing it to blister formation. The healing of blisters results in scar formation.
- Hidradenitis suppurativa: It causes deep wounds in the skin that leave behind scars after healing.
Symptoms of Scars
Symptoms associated with scar formation include:
- Itching or pricking
- Bumps on the skin
- Restricted movement of the body
Side Effects of Scars
The development of scars may produce some side effects, including:
- Severe itching
- Anxiety or depression due to self-consciousness
- Disturbed sleep
- Hampered daily routine
- Cracks in the skin
Diagnosing the cause and type of scar development is essential in determining the appropriate treatment. Accurate assessment of the scar helps a doctor decide on a therapeutic strategy involving the monitoring and management of the scar.
While the diagnostic procedure for most scars involves a simple physical exam, the doctor may suggest a biopsy if the cause of the scar is unknown, or it has an unusual shape.
Also, get your scars checked by a dermatologist as, rarely, scars may look similar to skin cancer, especially scars that develop without any injury or wound.
Keloids and hypertrophic scars are usually diagnosed through visual inspection and palpation.
If the doctor suspects a tumor, he may suggest imaging diagnostic tests such as MRI, CT, or ultrasound. The results of these tests may further be confirmed with pathological analysis of a biopsy. (1)
Medical Treatment for Scars
Various treatment options can help treat abnormal scars. These include: (2)
1. Surface treatment
Also known as skin resurfacing procedures, these treatments help remove the damaged skin layer, making way for new and healthy skin to form:
- Dermabrasion: This procedure is commonly used for minor irregularities in the skin surface, small scars, acne scars, and surgical scars. An electric machine is used to remove the top layer of the skin by scraping it. The healed and new skin that appears after the procedure is fresher and smoother.
- Chemical Peels: This treatment helps reduce sun damage, superficial scars, and irregular pigmentation of the skin. Chemicals are applied to the skin to aid in the removal of the surface layer of skin, therefore allowing newer skin to regenerate. This helps improve the skin appearance.
- Laser Resurfacing: Focused light is used generally to reduce the appearance of acne scars. It can be performed using wounding/ablative or non-wounding/non-ablative lasers.
Ablative lasers work by removing the scar and the top layer of the skin, stimulating the natural healing process. Non-ablative lasers work by inducing collagen production while leaving the skin intact.
2. Injection treatment
Three different types of injections are used for reducing scar appearance:
- Dermal fillers: These injections are typically used to plump up areas such as the cheeks, smile lines, oral commissures, and marionette lines, smoothening out the wrinkles.
The dermal fillers injected below the skin include semipermanent fillers, synthetic solutions, and hyaluronic acid.
- Cortisone injections: Corticosteroids are directly administered into a keloid or hypertrophic scar to help reduce its size. These steroids work by breaking the collagen fibers, therefore reducing the amount of scar tissue.
Also, steroids possess anti-inflammatory properties that aid in reducing swelling, itching, tenderness, and redness.
- Collagen injections: These injections are used to fill in the sunken areas with collagen, a natural protein. This treatment gives immediate results, but do not have a long-lasting effect. It is vital to ensure that you are not allergic to collagen before undergoing his treatment.
Different surgical interventions can treat major scars, which include:
- Cryosurgery: The surface layer of the skin is frozen to help reduce the size of the scar. This cold treatment, commonly done using liquid nitrogen, aids in the removal of superficial skin lesions such as actinic keratosis.
- Punch grafts: Scarred skin is replaced with small skin grafts to treat deep acne scars. The procedure involves punching a hole in the skin to remove the scar and then replacing it with undamaged skin, often taken from the back of the earlobe.
- Surgical scar revision: A scar that developed due to improper healing or other circumstances may be removed using plastic surgery techniques and repaired under local anesthesia. This allows the scar to re-heal in a controlled way.
Face sutures are generally removed within a week, whereas sutures in other parts of the body may be removed after up to 10 days.
4. Radiation therapy
If the scar is resistant to other therapies, radiation may be used.
Self-Care Tips to Manage Scars
The following lifestyle changes and self-care methods can help reduce the appearance of the scar:
- Use OTC creams, gels, or ointments: Topical medications can help lighten scars and are easy to use, cost-effective, comfortable, and non-invasive. These topical therapies, including imiquimod 5% gels and creams, help prevent or treat hypertrophic scars.
- Try scar massage: This involves the application of pressure over the scar using a pressure appliance, worn for up to 6 months continually. It works by stimulating the maturation of collagen and influencing the remodeling of the scar. It also helps reorient collagen fibers, improve pliability, and disrupt fibrotic tissue. (3)
- Use silicone sheets or gels: Silicone sheets or gels help create a waterproof seal over the scar, protecting the wound from bacteria and dirt. It maintains a moist environment ideal for skin healing.
The silicone gel can be spread similar to a thin sheet. It dries by itself within 5 minutes and works continuously throughout the day. It has shown to be effective in reducing texture by 86%, color by 84%, and height of the scar by 68%. (4)
- Opt for a skin camouflage: Special makeup suitable for covering scars is readily available in pharmacies. This type of makeup is especially useful in covering facial scars.
- Quit smoking: Smoking can interfere with the healing process and can worsen the scars. It is in your best interest to quit this habit.
- Protect your skin from the sun: Damaged skin can discolor on sun exposure for up to 6 months post-injury. Therefore, avoid exposure to the sun while your skin is healing. For this, you may cover the cut with clothes or use sunscreen after 2 weeks of the injury. The application of a broad-spectrum sunscreen also helps prevent hyperpigmentation.
- Exercise: Regular exercise can help prevent stiffness in the joints around the scar. Physiotherapy and exercise help release tensions arising from scar tissue and also improve tissue perfusion, thereby relieving articular contractures. (5)
Home Remedies to Treat Scars
You can help improve the appearance of scars using home remedies.
Onions are rich in medicinal compounds that stimulate the healing of a wound or injury and therefore help in reducing the formation of scars.
A study conducted in 2012 demonstrated that the use of a 12% onion extract gel could help reduce the height and other scar symptoms of a cesarean section scar. The gel was used thrice daily in the early postoperative period and did not produce any side effects. (6)
Another study showed that the daily application of an advanced formulation of onion extract gel could improve the appearance of new scars by influencing their redness, smoothness, and softness. The onion extract gel was found to be safe for use. (7)
A few studies showed the positive effect of onion extract gel on the appearance of scars, but further studies are required to establish its efficiency.
2. Vitamin C
Vitamin C is known to aid in the stimulation of collagen production, thus helping in the reduction of scars.
A study conducted in 2013 showed that the topical application of a silicone gel containing vitamin C could help improve fine surgical scars on the facial skin of Asians. (8)
Another study from 2016 demonstrated the safe and effective use of the hyaluronic acid sponge system along with vitamin C for scars older than 4 weeks, especially post-surgery. (9)
Some studies supported the topical use of vitamin C for scar reduction. However, more studies are required to conclude their efficacy.
3. Almond Oil
Almond oil has a high vitamin E and fatty acid content that helps in skin repair.
A 2012 study demonstrated the effectiveness of a 15-minute massage using almond oil during pregnancy in reducing the appearance of striae gravidarum. (10)
Another study conducted in 2018 supported the use of sweet almond oil in relieving the itch associated with striae and also preventing their progression. (11)
Almond oil has been shown to help prevent striae development. However, more studies are necessary to support this claim.
Scar formation can primarily be prevented by avoiding injuries, wounds, and accidents. If an injury does occur, the following tips can help reduce the likeliness of scar formation:
- Keep the cut, injury, or scrape clean at all times.
- Apply an ointment to the wound immediately.
- Use a bandage to cover the wound.
- Change the dressing regularly.
- Use sunscreen after the wound is healed to help fade the scar.
While you can treat minor wounds or scrapes at home, it is recommended to get professional medical help if you have a deep or painful wound or if your skin is infected.
Risk Factors for Developing Scars
Certain factors increase the chances of developing scars, including:
- Latin, Asian, or black ethnicity
- Age above 30 years
- Being a teenager
- History of scars in the family
Complications Associated with Scars
Often, scars can lead to the development of:
- Skin sensitivity
- Skin discoloration
- Skin contour irregularities
- Persistent pain
- Deep vein thrombosis
- Cardiac and pulmonary complications
- Problems with vision, feeding, and speech (if the scar is near the eyes or mouth)
At times, the scars may continue to grow beyond the scar margins and may even reappear after excision.
When to See a Doctor
It is advised to seek medical help if you have:
- A skin type that scars easily
- History of problematic scarring
- Delayed healing of the wound (more than 3 weeks)
What you may ask your doctor:
- Why did the scar develop?
- What steps can I take to prevent scarring post-surgery?
- What treatment option should I follow for my scar?
- Do I need to undergo surgery to remove the scar?
- Can I use an OTC cream for the scar?
- Is it safe for me to get tattoos or body piercings?
- Do I need to take any medications, and will they have any side effects?
- Am I at a risk of producing scars?
- Will the scar recur?
What your doctor may ask you:
- What type of scar do you have?
- Is the scar present by birth?
- Do you have any health problems?
- When did the scar develop?
- Have you undergone any surgery?
Scar formation occurs as part of the healing of wounds, such as burns, sore, cut, or other skin conditions. While scars can lighten with time, several treatments can help reduce the appearance of a scar.
Note that treatment is not always necessary if the scar is not producing any complications to your health. However, if you are bothered by your scar or are self-conscious of it, talk to your parents and doctor for enlightenment, guidance, and treatment.