Any interruption of the skin, whether from a fall on the ground, an accident on the job, or from the surgeon’s knife, prompts the complicated and not yet fully understood process of healing, the end result of which is a scar. However, the word “scar” often invokes the image of an unwanted deviation of the healing process, that which is a physical derangement from the smooth and non-discolored appearance of skin that it replaces.
As do the injuries from which they result, the appearance of scars can vary tremendously. Differing scar appearances are because the scars are different from each other. Different scar types are treated differently! Like all of medicine, successful treatment is based on establishing the diagnosis first. The wrong treatment method on a scar results in not only no beneficial effect but a waste of your time and money.
remain within the physical boundaries of the original skin injury. They are more likely to
occur in wounds that cross natural lines of skin tension or an original open wound that
healed on its own. These can cause some itching and discomfort to the touch but may
improve with time.
Keloids are also raised, reddish-purple, nodular scars that are usually firmer than hypertrophic scars.Keloids are the result of uncontrolled scar healing that the body does not stop once the wound is healed. The difference between keloids and hypertrophic scars is that keloids extend beyond the boundaries of the original injury site, encroaching upon surrounding uninvolved healthy tissue. Keloids can result from seemingly innocuous activities such as ear piercing and tattoos and unlike hypertrophic scars, keloids do not regress over time. While keloids can occur in all skin types, they are generally more common in darker skin.
Stretch Marks are linear bands of wrinkled skin that most frequently result from rapid weight loss or weight gain, for example following pregnancy, and tend to appear in areas like the abdomen, breasts, thighs, and hips. Initially, they tend to be red or purple, but often fade to white over time. They are essentially ‘partial tears’ on the underside of the skin from overextension.
Depressed Scars (atrophy) are due to the irreversible damage of the skin from the injury where the amount of scar formed is less thick than that of the surrounding normal skin. The level of the scar (thickness) is less than that of the surrounding skin. They can occur from a multitude of inciting events such as acne lesions, burns, or skin avulsive injuries from trauma. Trying to apply makeup to conceal depressed scars actually worsens their appearance as makeup enhances the textural variations.
Acne scars are a variety of depressed scars that have occurred due to loss of skin thickness from the body’s inflammatory response to a plugged sebaceous follicle. The inflammatory reaction (infection) results in thinning of the skin even though scar tissue has formed. Acne scars appear in a variety of shapes, which are important to distinguish, as they are often treated differently.
Icepick scars are usually narrow, sharply demarcated tracts that are wider at the surface and taper as they extend through the skin. Rolling scars are more superficial, wider, and produce an uneven appearance in the skin. Boxcar scars are round- to oval-shaped skin dimples with sharp margins and are wider than icepick scars.Most tend to have diameters from 2.0 – 4.0 mm.
Burn Scars are unique in that they have a very thin and atrophic underlying dermis. They are quite stiff and inflexible and do not heal well when cut and sutured. The fat layer underneath them is frequently gone or thinned due to the initial heat of the original injury. The burn scar can appear smooth and almost ‘glass-like’.
Scar diagnosis is critical to selecting the proper scar revision approach. These simple descriptions may help one better describe and identify their scar problem.
Dr. Barry Eppley