About Scarring

Scars come about either accidentally, through injuries, as a result of an illness that produces lesions, or as the inevitable outcome of surgery. Since there is a great deal of variation in the time a wound takes to heal – the size and depth of the wound, the blood supply to the area, the thickness and color of the skin, the direction of the scar, age, race, physical condition, etc. – there is a great deal of variation in the scarring a wound produces. And all scars are not created equal. Besides your garden variety scar that’s small and eventually disappears, there are different types of problem scars:

Keloids

Keloids result from a genetically more aggressive healing of wounds. This produces scars that go beyond the original boundaries of the wound. They are found mostly among darker-skinned people of African or Asian descent. Thick, puckered, itchy clusters of scar tissue, they are, in fact, benign tumor most commonly found over the breastbone, on the earlobes, and on the shoulders.

According to the American Society of Plastic Surgeons, keloids may be treated by injecting them with a steroid medication directly into the scar tissue. This will reduce any redness, itching, or burning, and may also shrink the scar. While their tendency to develop decreases with age, they have a tendency to recur, often larger than before. The scar tissue may be surgically removed and, to discourage the keloid’s return, the surgeon may apply steroids injected before and during the surgery, or use radiation. The patient may also have to wear a pressure garment over the area for as much as a year. Even with all that, the keloid may return and require repeated surgery every few years.

Acne Scars

Less commonly seen in today’s America than just 50 years ago, acne produces papules, pustules, or (in its most severe form) nodules on the face and elsewhere. These leave behind pits when they dry up and disappear. Severe cases leave victims with faces that appear to have been ravaged by smallpox.

Acne is caused by bacteria infecting pores that have been plugged up by oil and dead skin cells. The best way to deal with the scars is to treat the acne that causes them (Learn how to get rid of acne). The best medication to use is 2.5% benzoyl peroxide, which disinfects existing bacterial colonies and dries the skin to discourage future blockage of the pores. Precede treatment with a gentle wash with soap and water (keep it gentle; any rough treatment of the skin encourages more infection) and follow treatment with a non-oily moisturizing lotion.

Surgical treatments for deep acne scarring include subcision, punching, and collagen augmentation. For more shallow scars, dermabrasion, laser resurfacing, and chemical peels may be employed. Keep in mind that surgery of any type cannot proceed when there is any acne active on your body. Realize, too, that results of the procedures vary, that multiple treatments are generally required, and that each treatment runs anywhere from $300 to $3,000 per treatment; insurance seldom covers treatments.

For more information about acne scars and their treatments, see How to Get Rid of Acne Scars.

Contractures

When the human body experiences serious burns, the burns can go deep through the derma and into elastic connective tissue – muscle and tendons. Contractures develop when this tissue is replaced during healing by shorter, inelastic fibrous tissue which then restricts movement. Physical therapy, applied pressure, and stretching exercises do aid in controlling contracture burn scars, but surgery such as a skin graft or a flap procedure may also be required. Such new techniques as Z-Plasty or tissue expansion are also used in relief of the complications contracture scars create.

Hypertrophic Scars

Raised, red scars, these resemble keloids except that they stay within the boundary of the wound. Given time, they may disappear on their own. Most treatments, including dermabrasion, laser abrasion, surgically excising them, skin grafting, intra-lesional steroid injections, cryosurgery, radiotherapy, topical retinoids, collagen injections, silicone gel sheeting, and pressure dressings have produced results generally cosmetically unsatisfactory or inadequate; and the scars often reappear or worsen

Dr. Tina S. Alster reports that the only method to result in prolonged positive clinical outcomes has been laser scar revision using pulsed dye laser technology ("Laser treatment of hypertrophic scars,".)

A number of home remedies have been proposed for making scars go away (More tips on how to remove a scar). Some involve potato peels, others aloe, but most advocate some kind of oil (usually Vitamin E) rubbed into the scar. However, a skeptic of these treatments has pointed out that massaging a scar several times a day breaks down fibrous materials and makes it go away faster. Using any kind of oil acts as a lubricant to make the massage more effective.