What, why, and how does a scar form?
Our skin is a seamless organ that protects our bodies from harm. It inhibits us from pricking holes in ourselves. If you’ve ever had an injection or given blood, or accidentally nicked yourself with something sharp, you’ll know what I mean. Just one small cut can make a big difference in how it looks. Any burn, injury, or other trauma, such as surgery, can cause a scar.
What is a scar, you may ask. A scar is part of the body's natural healing process after tissue is damaged. When we injure the deeper layers of our skin, cells make collagen to repair the wound. Because your body makes this collagen quickly, it’s thicker and less flexible than the rest of your skin. This thicker, less flexible tissue known as a scar. New collagen continues forming for several months and the blood supply increases, causing the scar to become raised and lumpy. With time, some collagen breaks down at the site of the wound and the blood supply reduces causing the scar to gradually become smoother and softer. Although scars are permanent, they can fade over a period of up to 2 years. It's unlikely they'll fade any more after this time. The truth is, the scar will never completely go away but there are some methods that can help reduce its size and change its appearance.Let’s say an accident occurs, a fascinating process of healing begins that falls into three phases: inflammation, regeneration, and restructuring.
The inflammation phase begins as soon as the tissue is damaged and we start to bleed. In our blood the platelets, or thrombocytes, have a dual role: to stop the bleeding and to recruit immune cells, which play a central role in healing wounds. These cells cleanse the wound of bacteria, dead tissue, and foreign substances. At the same time, the dead cells give off substances that irritate free nerve endings, causing pain. Amazing right!? Your skin then produces various proteins, swiftly forming a temporary seal over the wound, and the inflammation continues until the damaged area has been cleansed.
In the regeneration phase, skin cells start to multiply in the area around the wound. Regeneration of skin cells results in new fibroblasts and keratinocytes. The fibroblasts produce collagen, thereby renewing the deeper layers of the dermis. The epidermis is regenerated by new keratinocytes. During the regeneration phase, the wound also begins to close gradually. This part of the process can take anything from a few days to several weeks.
This is followed by the restructuring phase, involving long-term skin repair through the restoration of the mix of collagen, elastin, and hyaluronic acid in the dermis. Scarring is the result of the bundles of collagen that form to stabilize the wound.
What are types of scars?
A scar can be a fine line or a pitted hole on the skin, or an abnormal overgrowth of tissue.
- Normal fine-line scars. A minor wound like a cut will usually heal to leave a raised line, which will gradually fade and flatten over time. This process can take up to 2 years. The scar will not disappear completely and you'll be left with a visible mark or line. Fine-line scars are common following a wound or after surgery. They are not usually painful, but they may be itchy for a few months.
- Keloid scars. These scars are the result of overgrowth of tissue that happens when too much collagen is produced at the site of a wound. They extend beyond the original injury and are raised above the skin and can be pink, red, the same color or darker than surrounding skin. They're often itchy or painful, and can restrict movement if they're tight and near a joint. Treatments include surgery to remove the scar, steroid injections, or silicone sheets to flatten the scar. Smaller keloids can be treated using cryotherapy (freezing therapy using liquid nitrogen). You can also prevent keloid formation by using pressure treatment or gel pads with silicone when you are injured.
- Hypertrophic scars. Like keloid scars these are raised, red scars but do not go beyond the boundary of the injury. They may continue to thicken for up to 6 months before gradually improving over a few years. Treatments include injections of steroids to reduce inflammation or silicone sheets, which flatten the scar.
- Contracture scars. If your skin has been burned, you may have a contracture scar. These scars tighten skin, which can impair your ability to move. Contracture scars may also go deeper, affecting muscles and nerves.
- Pitted or sunken scars. Cause by skin conditions, such as acne and chickenpox. If you've had severe acne, you probably have the scars to prove it. There are many types of acne scars, ranging from deep pits to scars that are angular or wavelike in appearance. Pitted scars, also known as atrophic or "ice-pick" scars, can also develop as a result of an injury that causes a loss of underlying fat. Treatment options depend on the types of acne scars you have.
Can we treat scars?
Complete scar removal is not possible, but most scars will gradually fade over time. A number of treatments are available that may improve a scar's appearance and help make it less visible. If scarring is unsightly, uncomfortable or restrictive, treatment options may include steroid injections, chemical peels, submission and filler, pressure dressings, using cryotherapy, radio frequency needling, or topical silicone gel or silicone gel sheets to flatten the scars when you are injured. Some people chose to have surgery or use make-up to camouflage the scar. Skin resurfacing and stimulation with lasers also helps reduce the appearance of scars. Often times a combination of treatments can be used to achieve the best overall results.
We hope that was informative on the what, how, and why scars form.