A scar is a mark that is left on the skin after a wound or an injury to the surface of the skin has healed. Scars are very common. Most people have at least one scar on their body. They are a natural part of the healing process and can occur inside and outside the body. Visible scars sometimes form after the skin has been broken. Scars can also occur on the internal organs – for example, where a cut has been made during surgery. Scars can also develop as a result of certain skin conditions, such as acne.
Scar tissue replaces normal skin tissue after the skin is damaged. Though scar tissue is made up of the same substance as undamaged skin, it looks different because of the way the fibers in the tissue are arranged. Scars form every time the skin is damaged beyond its first layer, whether that damage comes from a cut, burn, or a skin condition like acne or a fungal infection. Though there are ways to minimize the appearance of scars, there is no way to remove them entirely.
Scar tissue is a symptom in itself. It has limited blood supply, and this the reason why it appears paler and denser. As it is thicker than the surrounding tissue, it is quite conspicuous. During the healing period the body puts together the scar tissue in place of the destroyed tissue. However, it does not serve the function of the original tissue and this makes it to be limited in function, movement, circulation and sensation. A scar tissue is also characterized by damaged sweat glands, inability to grow hair and developing less resistance to ultraviolet radiation. Initially the scar may remain flat and pale and less noticeable. But with time as the body produces more of such fibrous scar tissues, the scar may become thick, raised and prominent. Other symptoms include decreased range of motion, due to the feeling of tightness or inability to move the joints normally. Numbness, tingling, pain, decrease muscle strength, restricted range of motion and feeling of the muscles being stuck.
Scarring is caused by the natural healing process when tissue in the body is broken. Breaks in the skin can be made in a number of ways, including:
Accidental injuries, such as cuts from falling off a bicycle
Deliberate harm from a weapon or from self-harm
Cuts made during surgery, such as a caesarean section birth
Bites and scratches from animals or people
Burns and scalds from hot objects or liquids
Piercings, such as ear or nose piercings
Scarring can also be a symptom of certain health conditions, such as scleroderma, which affects the connective tissue and causes hardening of the skin. Connective tissue provides support and structure to other tissues and organs.
Scarring can also be a side effect or a complication of other conditions. For example, if you have a condition that causes a rash, such as chickenpox or acne, and you scratch the rash, you may be left with scars where the rash was.
It is thought that you have an increased risk of developing keloid scarring or hypertrophic scarring if a member of your family has previously had these types of scars. This is because this type of scarring appears to run in families.
Internal scarring can be caused by injuries or surgery.
Human skin is made up of three main layers, the epidermis, dermis, and hypodermis. When the dermis — the pink middle layer in the cross-section of skin — is injured, the body first responds by making blood clot in the area to close off the wound. After the blood clots, the body then sends in fibroblasts, a type of cell that helps rebuild skin tissue. These cells break down the clot and start replacing it with proteins, primarily collagen, that make up scar tissue.
Though both scar tissue and normal skin are made with these collagen proteins, they look different because of the way the collagen is arranged. In regular skin, the collagen proteins overlap in many random directions, but in scar tissue, they generally align in one direction. This makes the scar have a different texture than the surrounding skin. Scar tissue is also not as flexible as normal skin, and does not have a normal blood supply, sweat glands, or hair.
How an individual scar looks depends on a few things, including the circumstances of the injury and a person's skin tone. For instance, a puncture wound causes a different looking scar than a burn wound, and whether the wound gets infected or not can also influence the appearance of the scar. A wound in a place where the skin is stretched tight, like the chest, often causes a thicker scar, since the body has to make more tissue to keep the wound from pulling open. Skin tone plays a role too. Though scars in general tend to turn white over time, those with dark skin may get scars that get darker with time. Those with darker skin may also be more prone to keloid scars.
There are five main types of scars:
Atrophic scars: These scars are sunken down into the skin. This type of scarring is often seen with acne scars or with wounds where skin or muscle is removed by an injury. This type of scarring can also happen when the body produces so much scar tissue in one area that it prevents new cells from growing where the wound took place.
Hypertrophic scars: These are usually red or purple and are slightly raised above the skin. They tend to fade and get flat over time.
Contracture scars: These types of scars often happen with burns, and end up pulling the skin in towards the site of the injury. This can make the skin look puckered around the wound.
Keloid scars: These are very elevated, red or dark scars that form when the body produces a lot of extra collagen in a scar. Keloid scars are actually a benign type of tumor, and often grow bigger than the area of the original injury. Those with darker pigmented skin are thought to be more prone to keloid scarring, but it's not clear why.
Stretch marks: Also called striae, these are considered a unique type of scar since they don't happen in response to an injury, but because of the skin being stretched rapidly, often during pregnancy or adolescence. The tissue here is often sunken a little into the skin, and tends to fade with time.
The formation of scar tissue after surgery can be reduced or delayed with the help of applying topical ointments such as, corticosteroids, anesthetic ointments and antihistamine creams. These products help the process of recuperation to speed up, while diffusing the scar tissue, and ultimately minimizing the scar. People suffering from scar tissue pain can go for a regular massage. This technique is especially beneficial for internal scars tissue, particularly on the muscles. Regular massaging enhances and stimulates circulation. This in turn aids in getting more oxygen delivered to the tissues for faster healing, and lightening of external scars.
Complete scar tissue removal is not possible, but the condition can be kept from getting worse, by taking regular medications and also, with the help of some natural home remedies. Common ones include treating the affected area with cucumber and lemon juice or with ice cubes. Application of vitamin E oil, using paste of sandalwood and black gram, massaging with Aloe vera gel or cod liver oil, or simply applying cocoa butter, provides great deal of help in reducing scar tissue.
If all such scar removal treatment and methods fail to improve the condition of a scar tissue, then patients may opt for laser treatment. This procedure works by destroying the blood vessels of the scarred area. This results in the formation of new cells and production of collagen, which help the scar to recuperate inside out. There is this another treatment known as magnetic therapy, which encourages blood circulation and breaks up the scar tissue at the affected area. This keeps the surrounding muscles from withering away. If nothing else works, then there is plastic surgery. Although, it cannot cure or remove the scar tissue, it can mask it and make it less noticeable.
Scars only need to be treated in the rare situation when they are painful or if a person is uncomfortable about how their scar looks.
Although scars cannot be removed completely, they can often be made less visible. Your doctor may refer you to a dermatologist or a plastic surgeon for treatment. Some of the treatment options are outlined below.
Corticosteroid injections are used to prevent and treat some keloid and hypertrophic scars.
Corticosteroids are injected into the scar to reduce any inflammation (swelling) and to flatten the scar. Depending on the type of scar, the corticosteroid injection may need to be repeated. Two or three injections are usually given a month apart, although this type of treatment may continue for six months or possibly longer, depending on how the scar reacts to the injections.
A local anesthetic may be combined with the corticosteroid to reduce any pain and discomfort.
Silicon gel sheets are available from some pharmacies. They are used on healing skin (not open wounds) and can help to treat and prevent hypertrophic and keloid scars.
To be effective, silicon gel sheets should be worn over the scar 12 to 24 hours a day, for two to three months. Most sheets can be reused until they dissolve. Both the scar and the silicone sheet should be washed with mild soap and water each day.
Silicone is also available as an ointment, which can be applied to your skin to help treat scars.
You can ask your doctor, dermatologist or pharmacist for further advice about using silicone gel sheets.
Sometimes, surgery can improve the appearance of scars. Surgery can be used to:
change the positioning of the scar
change the shape of the scar
release a tight scar that is close to a joint in order to improve movement
Be aware that having surgery on your scar will leave a new scar that will take up to two years to heal. There is also an increased risk of further keloid and hypertrophic scarring following surgery. After surgery, the recurrence rate for keloid scarring is 50-80%.
The aim of pressure dressings is to make scars less visible, and to flatten and soften them.
Pressure dressings are usually made from a stretchy, elastic material. They are worn over the scar 24 hours a day, for around 6 to12 months. They can also be used in combination with silicone gel sheeting to improve the appearance of scars over a long period of time.
Dermatologists may prescribe medication, such as potassium aminobenzoate, to help break down scar tissue. Medication is often used to treat conditions such as scleroderma, which can cause extensive scarring and hardening of the skin.
Though there is no way to entirely get rid of a scar aside from avoiding a skin injury, there are ways to minimize its appearance both while the wound is healing and after a scar has formed. Except for keloid scars, most scars will fade on their own even without treatment.
While the wound is healing:
Covering the wound with a bandage. This is particularly important before going out in the sun, since UV rays can cause the newly formed tissue to get discolored and may slow down the healing process.
Cleaning wounds properly. Doctors recommend cleaning a wound with a gentle soap and lukewarm water. Cleaning with hydrogen peroxide, alcohol, or iodine can all damage the newly forming cells and lead to a more noticeable scar.
Soothing gels. Rubbing aloe vera gel on the skin after the wound has closed can help lessen redness. Vitamin E gels are not recommended, since studies show that they are not very effective are minimizing scars.
Anti-itch cream. This can help with the urge to scratch or touch the healing wound, which could irritate it and make a more noticeable scar.
Pressure bandages. Some doctors say that putting a specific type of pressure bandage on a wound can help prevent the appearance of elevated scars since it pushes the collagen down. There are several different brand name versions of these bandages, which are often called scar therapy bandages or scar sheets.
Ways to minimize scars after they form:
Massage. Massaging a scar with lotion or a doctor-recommended gel can help fade many types of scars. This is particularly recommended for keloid scars, since this can keep them from getting sensitive and painful, and can help break down some of the built-up collagen.
Injections. Steroid injections may help with hypertrophic or keloid scars, and atrophic scars can sometimes be filled in with collagen injections. One downside to this type of treatment is that it is almost always temporary, and has to be repeated regularly.
Skin resurfacing. This can be done with lasers or with equipment that works like very fine sandpaper in a procedure called dermabrasion.
Cryotherapy. This is a technique of freezing the scar, and can reduce the appearance of keloid and hypertrophic scars.
In extreme cases, a doctor might recommend surgery. Though surgery can't get rid of a scar, it can make it less noticeable. Surgery is not recommended for hypertrophic or keloid scars though, since it can make them worse. Another type of treatment for severe scars is radiation therapy, which can sometimes reduce keloid and hypertrophic scars.