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by EBSCO Medical Review Board

Scars—Overview

Definition

A scar is skin that forms over a wound as the skin heals. There are five main types of abnormal 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, paper-like scars.
  • Pitted or acne —May look like deep pits or be angular and wavelike.

Causes

A scar is caused by an injury to the skin, such as a cut, scrape, puncture, or burn. It is part of the normal aging process. Scars are made of the same material as the surrounding skin, but it is made a little differently and appears different than the skin around it.

Risk Factors

Things that may raise the risk of scars are:
  • Deep injuries
  • How a person's skin scars—some people scar more easily than others
  • Where the injury occurred
  • How long it took for the skin to heal
  • Infections
  • Acne
  • Surgery
Normal Surgical Scar
Post-operative scar
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Symptoms

A scar may first look red and thick. It may feel numb, itchy, painful, or sensitive. Some scars may also cause physical problems, such as problems moving.
Over time, the scar will change. It often becomes less visible when it flattens and lightens. However, it may become raised, thick, sunken, or dark in color. The type and location of the wound will affect how noticeable the scar is.

Diagnosis

You will be asked about your symptoms and health history. A physical exam will be done. It will focus on the scar. You may be referred to a doctor who treats the skin.

Treatment

Most scars will fade over time, although they rarely go away completely. Some types of scars do not fade at all. Some people may be bothered by the way they look.
There are many treatments that can improve the appearance of a scar. Options are:

Creams, Ointments, and Gels

Over the counter and prescription products can be used for scars caused by surgery or injury. Some examples are:
  • 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 small acne scars or scars that are not deep.

Cryotherapy

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

Injections

Steroid injections into the scar may shrink scar tissue. It may be used for scars that stick out, such as 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 are:
  • 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 it.

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 are:
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
Skin graft surgery removes healthy skin from one part of the body and move 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. After 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. The type of laser will depend on the scar. Lasers may help to lighten pinkish-purple scars and flatten red scars.

Prevention

The risk of this problem may be lowered by:
  • Keeping wounds clean and covered
  • Not scratching or picking at scabs
  • Not popping pimples

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

References

Facial scar revision. American Academy of Facial Plastic and Reconstructive Surgery website. Available at: https://www.aafprs.org/Consumers/Procedures/FacialRejuvenation/Scar/A/FR11.aspx?hkey=cfe6e6de-ce9d-4d04-a25b-86a32301985f. Accessed September 14, 2021.
Keloid and hypertrophic scar. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/keloid-and-hypertrophic-scar. Accessed September 14, 2021.
Scars. National Health Services website. Available at: http://www.nhs.uk/Conditions/Scars/Pages/Introduction.aspx. Accessed September 14, 2021.
Tips for taking care of your skin. Kids Health—Nemours Foundation website. Available at: http://kidshealth.org/teen/your%5Fbody/take%5Fcare/skin%5Ftips.html. Accessed September 14, 2021.

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