Scars

What is a scar?

Whenever our skin is injured, the body launches a healing process that forms scar tissue. How your body mends itself and the depth of the wound will shape the type of scar formed. Aside from the most superficial scratches, virtually all skin injuries leave some degree of scarring. Scar tissue consists predominantly of a structural protein known as collagen, and scars can vary in size, shape, and sometimes cause discomfort. Although scars often lighten with time, there are a range of medical and aesthetic procedures designed to diminish their visibility, including laser therapy, steroid injections, and specialized topical treatments. These options can significantly improve both comfort and cosmetic outcomes for many individuals.

Types of scars

Scar classification is influenced by the nature of the initial damage and individual skin characteristics. The primary categories of scars are as follows:

Raised (hypertrophic)

These scars are among the most frequently encountered. They gradually diminish in prominence as they mature, yet they seldom become fully level with the surrounding skin. This scar type most often affects individuals between 10 and 30 years of age.

Flat

Initially slightly elevated, these scars level out as healing progresses. They typically appear pink or red at first and may later shift to a hue slightly darker or lighter than adjacent skin.

Depressed (atrophic)

Atrophic scars, often seen after conditions like acne or chickenpox, present as indented areas of skin. They arise because inflammation disrupts normal collagen formation. These indentations give the skin a sunken appearance and are most commonly found on the face.

Keloid

Keloid scars are overgrown, raised scars that extend beyond the original injury site. They commonly develop on the chest, shoulders, and back. Individuals with darker skin tones or red hair have a higher propensity to form keloids. These scars are also most prevalent among those aged between 10 and 30 years.

Contracture

Typically resulting from burns, these scars tighten and constrict the skin. When contractures affect muscles, nerves, or joints, they can significantly hinder range of motion and overall mobility.

Stretch marks

Rapid stretching or shrinking of skin can damage the underlying connective tissue, producing stretch marks. These lines often emerge during pregnancy, puberty, or with swift weight fluctuations. Common locations include the abdomen, breasts, upper arms, and thighs. While these marks typically fade as the skin remodels, certain creams and therapies can accelerate this process.

What causes scars?

Almost everyone develops some form of scarring. Many events can trigger scars:

• wounds and injuries
• burns
• skin disorders such as acne or chickenpox
• insect bites
• piercings
• tattoos
• surgical procedures
• pregnancy
• rapid weight gain or loss

Which factors affect scar appearance?

The look of a scar varies according to:

• the injury’s origin
• its size, depth, and location
• the quality of wound care received
• age
• ethnicity
• genetic predisposition
• overall health

How do scars develop?

A scar forms when a wound penetrates the dermis, the inner layer of skin. To mend damage that extends beneath the epidermis, the body generates thicker, collagen-rich tissue that creates the scar. This repair tissue is often less elastic than normal skin, altering its texture. In their early phase, scars often appear pink or red, then over time they may become either lighter or darker than the surrounding skin.

What complications can arise?

While most scars are harmless, they can sometimes become itchy, painful, or restrict movement. Moreover, larger or highly visible scars, particularly those on the face, can cause emotional distress.

How can you minimise the look of scars?

Since scars cannot be entirely erased, treatments focus on reducing their visibility. A variety of approaches can help improve the appearance of scars:

• Topical agents, Applying over-the-counter products like vitamin E cream, cocoa butter, silicone gel, specialized oils, onion-extract formulations, and other commercial skin preparations may support scar healing.
• Corticosteroid injections, These injections can flatten raised scars and relieve associated itching or discomfort.
• Dermabrasion, By removing the skin’s surface layer, dermabrasion treats both elevated and sunken scars; microdermabrasion is reserved for more superficial irregularities.
• Laser therapy, Laser treatments vaporise the scar’s outermost layer, stimulating new collagen growth and improving scar pigmentation.
• Filler injections, Dermal fillers lift depressed scars, though results are temporary and repeated sessions may be needed.
• Microneedling, Creating tiny punctures in the skin triggers collagen production, helping to smooth the scar’s texture.
• Cryosurgery, Freezing scars can reduce pain, itchiness, and discolouration while softening rigid tissue.
• Surgical revision, Excising or reshaping a scar can make it less noticeable; however, this is usually avoided for keloids due to the risk of more aggressive scar recurrence.
• Radiotherapy, Low-dose radiation may prevent severe keloid or hypertrophic scars from returning, but its potential cancer risk limits its use.

When should you see a doctor?

Although most scars are harmless, consult a physician if a scar itches, hurts, restricts movement, or causes emotional distress. Your doctor can refer you to a dermatologist for further assessment and personalised treatment.

Can scar formation be prevented?

While it isn’t always possible to avoid scars entirely, proper wound care can lessen their size and severity. After an injury, you should:

• Have deep wounds closed by a healthcare professional with sutures or dressings to reduce scarring
• Keep the area clean to prevent infection
• Seek medical attention and antibiotics if you suspect an infection
• Maintain a moist wound environment with suitable dressings, as dry scabs can worsen scarring
• Protect the healing skin from UV exposure with sunscreen or clothing, since sunlight can darken scars
• Follow a nutritious diet rich in protein and vitamins C and D to support skin repair
• Avoid popping or squeezing pimples
• Treat skin conditions promptly to minimise itching and inflammation