Scars

Definition

Scars are marks created during the healing of damage to the skin or tissues.

Description

A scar is a manifestation of the skin's healing process. After skin or tissue is wounded, the body releases collagen to mend the damage. Collagen, a protein, reattaches the damaged skin. As the wound heals, a temporary crust forms and covers it. The crust is a scab that protects the damaged area.

Causes of scars include cuts, sores, surgery, and burns. Severe acne and chicken pox may also scar skin. The degree that skin scars depends on more than the size and depth of the wound. Age also affects the process. The healing process is stronger in younger skin. That results in scars that are thicker than those of older people. Other factors affecting the type of scar are ethnicity, heredity, and the location of the injury.

Children are active and susceptible to cuts and injuries. They and people with fair complexions tend to get hypertophic scars. While Asians and blacks are likely to have keloid scars, people from other ethnic groups also experience this form of scarring.

Keloid and hypertophic scars have similar appearances. However, the keloid scar expands beyond the original wound.

The location of the wound also has an effect on its size. If the scar is located on places like the knee or shoulder, it will eventually widen because these areas are in motion.

Treatment could minimize a scar but will not erase the mark.

Causes and symptoms

Scarring is the natural process of repairing an open wound, injury, surgical incision, or other conditions like acne. Initially, a scar is red because blood vessels are created while the body forms scar tissue. The damaged area is covered by a protective scab that eventually falls off. The scar may become brown or pink. It generally fades over time and becomes less visible.

The healing process takes from one year to 18 months. Some scars heal naturally. Other scars require additional treatment.

Hypertophic scars and keloids

Hypertophic scars and keloids are caused by an over-active healing process. This produces an excessive amount of collagen at the wound site. Both types of scars are red, thick, and raised above the wound.

Hypertophic scars do not extend beyond the wound site. The scar may itch and usually heals without professional treatment in about a year.

Keloids are large scars that could form after surgery, an injury, burn, or body piercing. This scarring often occurs on the ear lobe or chest. Sometimes keloids develop spontaneously.

The keloid is raised, rigid, and grows beyond the wound. The keloid can continue to grow. Scars are generally harmless, but may itch or feel tender. In addition, a person may feel self-conscious about the scar's appearance.

Contracture scars

Contracture scars are caused by the loss of a large section of skin due to burns or other injury. The scar contracts or tightens around the wound. This contraction could impact a person's mobility. If the scar deepens, it could affect muscles and nerves.

Acne scars

Acne scars may appear after the severe stage of acne, a skin condition usually caused by hormonal changes. The inflammatory condition is seen in adolescence, but acne can occur later in life.

Severe acne is triggered by clogged pores that cause bacteria to multiply. It occurs more frequently in adolescent boys than girls. If the acne is not treated, there could be scarring. The types of scars include pit-like pockmarks.

Diagnosis

Since visible scars could make people self-conscious, they will probably seek treatment rather than a diagnosis. Medical professionals who treat scars include dermatologists and plastic surgeons. Dermatologists are physicians who care for the skin. Their expertise includes three or more years of medical and surgical training.

Scar treatment is usually not covered by insurance. Cosmetic procedures, those done to improve a person's appearance, are considered elective surgery and are paid for by the patient. However, if scars cause a physical impairment, coverage may be issued. Examples of impairments include burn scars and keloids that restrict motion. For coverage to be approved, it is helpful for the primary care doctor to document the patient's case in writing.

Treatment

A scar is permanent and cannot be completely removed. However, treatment can alter a scar's appearance. These procedures range from the application of over-the-counter ointment to surgery. Scar treatment should start after an injury because wound care affects scarring. The wound should be cleaned and covered. Picking at the scab breaks the collagen and allows germs to enter the wound. Time also helps with healing. Scars become smaller, and the color fades.

However, additional treatment is required for some scars. While some procedures are more effective for keloids and hypertrophic scars, the procedure for acne scars is based on the type of scarring. Treatment for burn scars may include skin grafts surgery.

Surgery

The surgical procedure for scars is referred to as scar revision because the procedure modifies the scar's appearance. The cost of scar revision averaged $1,129 in 2003, according to a membership survey of the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS).

This procedure works well on scars that are wide or long. Other treatments may be recommended for keloids because a surgical incision could cause a new scar and create another keloid. To reduce the risk of another scar, surgery may be followed by the injection of cortisone steroids.

Steroid Injections

Steroid injection is a singular form of treatment for scars, particularly keloid and hypertophic scars. Corticosteroids are an anti-inflammatory drug that helps to lessen the scar's red color and thickness. The treatment flattens the scar and helps with itching. Injection costs vary and could cost $150 per scar, according to a member of the American Academy of Dermatologists (AAD).

Cyrosurgery

Cryosurgery involves the freezing of freezes tissue with a probe containing nitrous oxide. It is used to modify scars, especially keloid and hypertrophic scars. Treatment vary could cost $175 per lesion, according to the AAD member.

Dermabrasion

Dermabrasion is the removal of a layer of the skin's surface. Scars including those caused by acne are smoothed or sanded by an instrument. The procedure costs approximately $150 per treatment.

Silicone gel sheets

Silicone gel sheets can be purchased over-the-counter. The sheets are worn over the scar area to seal moisture. The treatment helps with itching and to reduce scar thickness and color. Cost of sheets for small wounds ranges from $30 to $50.

Alternative treatment

Alternate methods of treating scars range from applying Vitamin E to massaging the skin. People should consult with a doctor or other health care professional before starting treatment involving contact with the scarred area.

These procedures include applying obtained Vitamin E, aloe vera, or cocoa butter to the scar. Vitamin E is sold as an oil or obtained by opening a vitamin capsule. Aloe is an African plant and is sold I capsule form and as a skin care product. Cocoa butter is a fat made from cacao seeds.

Those items are thought to help with healing so that a scar is less visible. However, time also helps to lessen the scar's appearance. Those substances should be applied only after a scar is well-healed.

Massaging mild scars is done to relax rigid scar tissue. The scar is massaged for about two minutes. Afterwards, Vitamin E oil is applied to the skin. The process should be discontinued if the area becomes sore or red.

Prognosis

The prognosis for scar treatment depends on factors including the type and severity of the scar. Keloids may return, and all scars are permanent. If treatment does not completely minimize a scar to the patient's satisfaction, the person can apply make-up to the scarred area.

Prevention

The primary way to prevent scarring is to avoid injuries. People should wear protective gear when participating in sports. Furthermore, acne should be treated before the condition reaches the severe stage.

If injured, a person should immediately treat the wound because this reduces the risk of scarring. The wound should be cleaned and covered. If stitches aren't needed, a butterfly bandage is effective at keeping the wound closed. Moreover, a balanced diet also helps with the healing process.

Picking at the scab should be avoided because this interferes with the healing process and raises the risk of scarring.

Resources

BOOKS

Turkington, Carol. Skin Deep: An A-Z of Skin Disorders, Treatments, and Health. Facts on File, Inc., 1998.

PERIODICALS

ORGANIZATIONS

American Academy of Dermatology. 1350 I Street NW, Suite 870, Washington, DC 20005-4355. 202-842-3555. 〈http://www.aad.org〉.

American Academy of Facial Plastic and Reconstructive Surgery. 310 South Henry Street, Alexandria, VA 22314. 703) 299-9291. 〈http://www.aafprs.org〉.

American Society of Plastic Surgeons, Plastic Surgery Educational Foundation. 444 East Algonquin Road, Arlington Heights, IL 60005. 847-228-9900. 〈http://www.plasticsurgery.org〉.

OTHER

Treatment of Scars WebMD Medical Reference in collaboration with the Cleveland Clinic, Department of Plastic Surgery. September 2003 [cited March 28, 2005]. 〈http://my.webmd.com/content/article/76/90236.htm〉.

What is a Scar? Academy of Dermatology pamphlet, 2004 [cited March 28, 2005]. 〈http://www.aad.org/public/Publications/pamphlets/WhatisaScar.htm〉.

AAFPRS 2003 Statistics on Trends in Facial Plastic Surgery American Academy of Facial Plastic and Reconstructive Surgery. 2004 [cited March 28, 2005}. 〈http://www.aafprs.org/media/stats_polls/AAFPRS%20MEDIA%202004%20-%20Final.pd〉.

scars Any disruption of the body surface, or of internal organs, will leave a scar, although the most skilful surgical repair can result in a scar which is virtually invisible. Permanent physical evidence of injury on or in the body is the end-product of a complex and highly effective system of repair. However skilful the mending of a tear in a man-made fabric, it does not achieve actual restoration of continuity between the interwoven threads: likewise for the skin and for internal tissues.

When injury — accidental or deliberate — or surgery breaks the skin, the normal wound healing processes result in restoration of continuity of the protective surface layer. Any gap is filled by a covering of epithelium, with an underlying layer of fibrous connective tissue, but this new ‘skin’ does not develop the full character of normal skin — there are no sweat glands, and no hairs. If the edges of a wound have been held close together during the healing process by stitching, or by careful dressing for smaller wounds, the gap — and therefore the final scar — is minimal. At the other extreme, a widely gaping wound will be covered over, but it may end up as an unsightly streak of ‘keloid’ tissue, or ‘welts’, lying proud and purplish above the surface of the adjacent normal skin.

Scarification, artistic marking of the body, practised around the world but especially in Africa, is used to indicate social status, progress through the cycle of life, or familial and dynastic affiliations. It is also employed to enhance bodily beauty and as medical treatment (cuts above the eyes are said to aid sight and those on the temples to relieve headaches). Among the Nubians, for example, one can read a woman's marital and fertility status in her skin. At puberty, Nubian women are marked by a pattern of scars on either side of their abdomens that join at the navel and continue into a point between the breasts. With menarche a second set of cuts are made in parallel rows under the breasts which continue around to the back and cover the entire upper body. After weaning her first child, a woman is marked with raised welts over her back, neck, arms, and buttocks to the knees. In Southern Egypt and Sudan these raised scars are made by a hooked thorn used to lift the skin, which is then cut with a small blade; ashes or indigo are often applied make the scars more prominent.

Scarring is common among both sexes. In men, the scars often indicate social standing or physical ordeals of individual valour. In the early part of the twentieth century, for instance, male students at German universities proudly bore duelling scars.

Sheila Jennet, and Londa Schiebinger

Bibliography

Brain, R. (1979). The decorated body. Harper and Row, New York.