What is Scarring?

Scarring occurs after a traumatic, medical, or surgical injury occurs to the skin or other tissue on the body. The cells which produce collagen, fibroblasts, produce excessive collagen which forms abnormal healing of the injury or wound. The abnormal healing results in a pink, red, or purple colour which can be painful or itchy depending on the type of scarring that occurs. While scars are often benign, they can cause distress to an individual and impact on self-esteem.  Scars can also at times cause functional problems such as decreased range of motion if the wound is located at a joint.

 

What kind of scars are there?

There are two main types of abnormal scarring; keloid and hypertrophic. While both types of scars are similar physiologically, there are a few key differences and treatments for each. A dermatologist can diagnose and recommend the best treatment for each.

 

Hypertrophic Scars

Hypertrophic scars are the most common type of scar and seen often by dermatologists. Hypertrophic scars are characterized by a raised smooth surface on the area of the wound. The scar can be reddish or pink in color. Hypertrophic scars do not grow beyond the size of the wound. There are occasions hypertrophic scarring may improve spontaneously.

 

Keloid Scars

Keloid scars are raised smooth areas formed from the healing of a wound. They can be red or purple in color. Keloid scars often spread beyond the site of an original wound which distinguishes them from hypertrophic scars. Keloid scars commonly affect the areas from the sternum up and are commonly seen on the ear lobes, chest, shoulders, and neck. Keloid scarring can be an issue with pierced ears causing large bulbous scars on the ear lobes.

 

There are several risk factors for keloid scars. Keloid scars can be linked to genetics and passed on as a dominant gene. Those with darker skin tone are more prone to keloid scars. Cutaneous injury above the sternum puts you at higher risk for keloid scars. Keloid scars can be caused by surgery, pierced ears, acne, and even shaving can cause keloid scars.

 

The risk age for keloid scars is 10 to 30 years old. In the younger population, scars are more prevalent due to the rate of injury, the elasticity of the skin and the higher rate of collagen production.

 

Professional Assessment of Scars

A dermatologist may assess a scar for appropriate diagnosis and categorisation.

 

Treatments for Scars

While there is no cure for scars, there are several treatments that can help reduce the visibility of scars. Most treatment options will call for a combination of treatments to ensure effectiveness.

 

Excisional Surgery

Excisional surgery is a procedure performed by dermatologists and plastic surgeons. With a local anaesthetic, some scars may be appropriate to be cut out.  The remaining skin is stitched using a variety of methods depending on the location and type of scar.  Cortisone injections are often used after surgery.  This can be a treatment option for some scars, but at times may result in more keloid scarring.

Injections

Various types of injections can help reduce the size and visibility of scars. Corticosteroid shots can be given to help break down the excess collagen in the scar.  A special formulation combining cortisone and other agents can be used to reduce inflammation and may help flatten scars.

Vascular Laser and Laser Genesis

When scars are red or purple, lasers can be used to help scars blend in to surrounding skin.