A scar appears as a result of an injury or another skin damage. The scar is connective tissue which is formed during the process of healing, which replaces the tissue damaged by the injury or disease. Development of the scar constitutes part of the normal wound healing process. The period of wound purification is followed by penetration of blood vessels and depositing of collagen fibres which are first arranged in a random, and later in an organised manner. At the beginning, the scar is red, then it gradually becomes more pale. The process, referred to as maturing of the scar, takes approximately 1-2 years. After some time, the appearance of the scar does not change anymore. Some scars do not mature and they continuously produce collagen which results in their hyperthrophy or even development of a keloid.
Factors influencing appearance of the scar:
- Length, bleeding, pressure,
- Wound healing process – bleeding, purulence,
- Age (in case of elderly persons, poorer healing is observed),
- Cuts in the lines of minimum skin tension,
- Shape of the scar,
- Number and kind of sutures applied,
- Location of the scar (chin, breastbone, arm and upper part of the back are areas of increased risk),
- Genetic predispositions (there are persons who always produce nice looking scars, while there are others who always develop keloids).
Most scars do not require specialist treatment and they heal without any intervention; as a result, natural removal of the scar takes place. However, there are abnormal scars, which are hard, red, thickened, considerably exceeding the original shape and size of the wound. Not only do they constitute an aesthetical problem, but above all a health problem, as they may cause contractures, cause pain and itching.
Kinds of scars by reason of development
- By origin:
- Post-inflammatory – developed as a result of inflammatory or purulent changes, e.g. in the course of acne or chickenpox.
- By appearance:
- Atrophic – these involve cavities (atrophic areas) in the skin. Produced mainly as a result of an inflammation in the course of acne, chickenpox and other diseases. They may be single or very numerous, with different depth and shapes – dot-shaped, with sharp edges, larger cuppings with mild edges, linear atrophic scars.
- Hypertrophic (convex) – presence of scarred, hard, elevated thickened tissues of various sizes and shapes. They appear within post-surgical, post-traumatic, post-burning and post-inflammatory scars.
- Keloids – usually formed at the place of skin injury: after a surgery, injection, recessing inflammatory changes (acne, chickenpox, follicle inflammation), after burns. Keloids appear as convex nodes which significantly go beyond the place of the injury. At the beginning, they grow gradually and they may reach from several millimetres to several centimetres in size.
An ideal scar ought to be narrow, on the skin level and as similar to the surrounding skin in colour as possible. Some scars are nearly invisible. Unfortunately, some scars do not produce enough collagen to cover the deficiency and they become atrophic scars.
Handling of scars to obtain optimum appearance:
- Pressure – pressure dressings, e.g. in case of post-burning scars, massage;
- Greasing of the scar (the scar does not have natural sebum);
- Application of ointments or silicone plasters during the initial period – as soon as the wound heals;
- Application of sea onion extracts; application of those ointments must not begin too soon as, by dissolving collagen, they may cause an effect different than planned; therefore, their application may begin after approximately 2 months;
- KTP and VPL laser treatments.
Treatment of hypertrophic, atrophic scars and keloids:
- Dermatosurgery – cutting out of the scar and re-sewing;
- Plastic surgery involving relocation of skin flaps (in extensive scars, e.g. post-burning scars);
- Occlusion dressings with steroids;
- Steroid injections (in case of a mature, hard scar, it is sometimes impossible to insert the needle, and the scar needs to be loosened first, e.g. by cryotherapy treatment);
- Chemical peel;
- KTP and VPL laser treatment – these perfectly hinder hypertrophic processes in the scar, which is red and contains many capillaries during the maturing stage. In case of a known tendency to scar hypertrophy, it is in fact a method of choice, which stops the hypertrophy process during an early period;
- Microdermabrasion (especially for acne scars);
- Fraxel Dual, Fraxel CO2 laser treatments – these allow reconstruction of the scar throughout its structure and achievement of its transformation into a less mature, better vascularised form. The reconstructed scar heals in a new way, allowing achievement of surface levelling and equalisation of its colour. Ideal effects may be achieved in acne-scarred skin. Whether atrophic or hypertrophic features dominate, we achieve levelling of the skin, equalised colour, removal of discolourations;
- Mesotherapy – by delicate injections, substances which strongly stimulate collagen production are supplied to the scar, e.g. organic silica. In case of atrophic scars, this is an excellent way to stimulate reconstruction of the scar in the desired direction.
Treatment of keloids:
- Injections of triamcinolone – steroid medicine. A few treatments are usually performed, at the intervals of several weeks, involving supply of the medicine at the appropriate concentration. The effect develops gradually;
- Cryosurgery – method involving destruction of tissues by local low temperature impact. Freezing may be connected with triamcinolone injection treatments. The method is effective. From one to several treatments are performed. Its disadvantage is relatively long time of healing, which is 2-3 weeks;
- Vascular laser – may be useful in the treatment of growing, red keloids;
- Silicone based gels;
- Pressotherapy – treatment by pressure.
The treatment of scars and keloids needs to be highly individualised, depending on:
- The patient’s age
- Shape, size and location of the scar
- Maturing stage
- Previously applied correction methods
- Genetic predispositions