Scars

A scar is a mark that is left on the skin after a wound or an injury to the surface of the skin has healed.

Introduction

A scar is a mark that is left on the skin after a wound or an injury to the surface of the skin has healed.

Scars are very common – most people have at least one on their body. They are a natural part of the healing process.

Scars can occur inside and outside the body. For example, they can occur on the internal organs where a cut has been made during surgery, and can develop after certain skin conditions, such as acne and chicken pox.

How do scars form?

When the skin is wounded and there is a break in the body’s tissues, the body produces more of a protein called collagen as part of the healing process. Collagen builds up where the tissue has been damaged, helping to heal and strengthen the wound.

For a period of about three months or longer, new collagen continues to form and blood supply increases, causing the scar to become raised, lumpy and red. Some collagen then breaks down at the site of the wound, the blood supply reduces and the scar gradually becomes smoother, softer and paler.

Although scars are permanent, they can fade over a period of up two years. After this time, it is unlikely they will fade any more.

Skin wounds can be caused by many things, including:

Read more about the causes of scars.

Where do scars form?

Scarring is unpredictable and varies from person to person. Certain areas of the body are more at risk of scarring, such as the chest, the back, the ear lobe and the shoulder.

Scars that form on the knees and shoulders can appear stretched or widened as a result of the healing process occurring over movable joints.

Types of scars

The different types of scars include:

  • hypertrophic scars – red, raised scars that form along a wound and can remain this way for up to five years
  • keloid scars – caused by an excess of scar tissue produced at the site of the wound where the scar grows beyond the boundaries of the original wound, even after the wound has healed
  • pitted (atrophic or 'ice-pick') scars – with a sunken appearance
  • contracture scars – caused by the skin shrinking and tightening, usually after a burn, which can restrict movement

Read more about scar types.

Treating scars

Depending on the type and age of a scar, a variety of different treatments may help make them less visible and improve their appearance.

Scars are unlikely to disappear completely, although most will gradually fade over time.

If scarring is unsightly, uncomfortable or restrictive, treatment options may include:

  • silicone gel sheets
  • pressure dressings
  • corticosteroid injections
  • cosmetic camouflage (make-up)
  • surgery

Often, a combination of treatments can be used.

Read more about treating scars.

Emotional effects

Scarring, particularly when it is on the face, can be very distressing. It can feel as if you are being stared at. If you avoid meeting people as a result of your appearance, you may become socially isolated. This can lead to feelings of depression.

If you feel that your scars are making you depressed or affecting your daily activities, visit your doctor.

Preventing scars

It is not possible to prevent scars from forming, but there are things you can do to help your scar be less visible and heal better, such as immediately cleaning dirt, objects and dead tissue from wounds.

Other ways to improve scarring include:

  • avoiding scratching or picking at scabs and spots
  • covering wounds with a waterproof ointment (such as Vaseline)
  • using silicone gels or sheets to reduce redness and encourage healing

Symptoms

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Scars on the skin may appear when a cut or other injury is in the process of healing. The different types of scars vary in appearance.

Normal scars

At first, a normal scar may be red and look sore, but it will usually fade as the injury begins to heal. If the skin at the edges of the wound has come together neatly, the scar will usually heal as a thin, pale line.

In wider wounds, where more surface skin is missing and more scar tissue is needed to bridge the gap between the edges of damaged skin (such as a bad graze on the knee), the scar may be less neat and may take longer to heal.

Normal scars are not usually painful, although they may be itchy for some months. They can also be quite dark in colour and unsightly.

If you have a darker skin type, scar tissue may fade to leave a brown or white mark. These are often permanent, but can sometimes improve over time. If your skin is tanned, the scar may appear more obvious as scar tissue does not tan and remains pale.

Other scars

Keloid scars

A keloid scar is an overgrowth of tissue that occurs when too much collagen is produced at the site of the wound and the scar keeps growing, even after the wound has healed.

They often have the following characteristics:

  • it is often raised above the skin
  • it can feel itchy
  • it can feel painful
  • it can appear much larger than the original wound
  • it can cause a burning sensation and feel tender to touch
  • it can restrict movement if it is tight and near a joint
  • it is raised above the skin
  • it is hairless and appears shiny
  • it feels hard and has a ‘rubbery’ texture, although some keloids can form soft lumps (such as on the ear lobe after piercings)
  • a newly formed keloid scar is red or purple, becoming paler with time

The areas of the body where keloid scars are more likely to form include:

  • the area around the breastbone (sternum)
  • the upper arms and shoulders (deltoids)
  • the upper back
  • on the ear lobes

Hypertrophic scars

A hypertrophic scar is a red, raised scar that forms along a wound and can have the following characteristics for around two to five years:

  • it can restrict movement because scar tissue is not as flexible as the original skin
  • it heals within the size of the original wound
  • the healing tissue is thicker than usual
  • it is red and raised initially, becoming flatter and paler with time

Hypertrophic scars can have this appearance for many years.

Pitted scars (atrophic or 'ice-pick' scars)

Some scars caused by skin conditions such as acne and chickenpox can have a sunken or pitted appearance.

Scar contractures

Scar contractures are commonly caused by burns. These occur when the skin “shrinks”, leading to tightness and a restriction in movement.

Causes

Scarring results from the body's natural healing process after body tissue has been damaged.

Tissue damage can occur for a number of reasons, including:

  • accidental injuries, such as cuts from falling off a bicycle
  • deliberate harm from a weapon or from self-harm
  • cuts made during surgery, such as a Caesarean section birth
  • bites and scratches from animals or people
  • burns and scalds from hot objects or liquids
  • body piercings, such as ear or nose piercings
  • injections, such as vaccination against tuberculosis (BCG vaccination)
  • tattoos

Scarring can also be a side effect or a complication of other conditions. For example, if you have a condition that causes a rash, such as chickenpoxor acne, you may be left with scars where the rash was (more likely if you scratch or pick at the affected areas).

It is thought keloid scarring and hypertrophic scarring may run in families. This means you have an increased risk of developing keloid scarring or hypertrophic scarring if a member of your family has previously had these types of scars.

Internal scarring can be caused by injuries or surgery.

Treatment

People seek help for scars if they are painful or itchy, if they are unsightly, or if they restrict movement.

Although scars cannot be removed completely, they can often be made less visible. However, more research is required to assess the effectiveness of the different treatments.

Your doctor may refer you to a dermatologist or a plastic surgeon for treatment.

Corticosteroid injections

Corticosteroid injections are used to treat some keloid and hypertrophic scars.

Multiple small injections are made into the scar to reduce any inflammation (swelling) and to flatten the scar. Depending on the type of scar, these may need to be repeated. Usually injections are given on three occasions at 4-6 week intervals to assess your body’s response. Sometimes treatment may continue for several months if the scar is improving.

This treatment cannot remove scars, but it can improve their appearance.

Silicone gels or sheets

Silicone gels or sheets are available from some pharmacies. They are used on healing skin (not open wounds) to reduce redness and try to minimise hypertrophic or keloid scars.

To be effective, silicone gels or sheets should be placed over the scar for 12 hours a day, for at least three months.

You can ask your doctor, dermatologist or pharmacist for further advice about a range of silicone-based scar treatments.

Surgery

Sometimes, surgery can improve the appearance of scars. Surgery can be used to:

  • change the positioning of the scar
  • change the width or shape of the scar
  • release a tight scar that is close to a joint, to improve movement

Be aware that having surgery on your scar will leave a new scar that will take up to two years to improve in appearance. If surgery is used to treat a hypertrophic scar, there is a risk that the scarring may be worse after the surgery.

Surgery alone is not advised for keloids as they tend to grow back larger. Surgery for keloids is often combined with corticosteroid injections at the site of the removed scar immediately after the surgery. Some plastic surgeons also add other treatments, such as X-ray therapy and oral antibiotics to try and minimise recurrence of a keloid that has been surgically treated. You can talk to your surgeon about this.

For some pitted scars, laser surgery (laser re-surfacing) is used. This involves using a laser to remove the top layers of skin, stimulating collagen production in the deeper layers to try to make the scar flatter.

Pressure dressings

The aim of pressure dressings is to flatten and soften scars. They are most often used for large burn scars or after some skin grafts.

Pressure dressings are usually made from a stretchy, elastic material. They are worn over the scar 24 hours a day, for around six to12 months. They can also be used in combination with silicone gel sheeting to improve the appearance of scars over a long period of time.

Pressure dressings are usually used under specialist supervision.

Make-up

Cosmetic camouflage (make-up) can help cover up scars and can be particularly useful for facial scars. Some are waterproof and can stay in place 2-3 days.

Camouflage make-up that is specially designed for covering up scars is available over the counter at pharmacies. Alternatively ask your doctor for advice.

Please note that camouflage colour testing (to get a good colour match for your skin type) can be a lengthy process, sometimes taking over an hour, and needs to be performed by somebody who is qualified.

Other treatments

Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue.

Dermal fillers are injections (often of a man-made acid) used to 'plump up' pitted scars. Treatments can be costly and the results are usually temporary. Repeat treatments are needed to maintain the effect.

Skin needling, which involves rolling a small device covered in hundreds of tiny needles across the skin, is also reported to be helpful, but repeat treatments are often needed to achieve an effect and results vary considerably.

Real stories

Nicola, an office administrator from Newcastle, was involved in a bad road accident that caused serious injuries to her face. Her four-year-old daughter escaped with a broken collarbone.

Nicola needed 158 stitches in hospital. And as she was eight months pregnant, she couldn't have any anaesthetic to ease the considerable pain.

She said: "I had to grin and bear it – I still haven't really recovered even now. I felt really devastated when I realised that I would have a scar 8 inches across one side of my face. One part is really bad, where the skin is more jagged than the rest."

Fortunately, the young mother gave birth to a healthy boy a month later. However, she was still upset by the prominent scar across her face. Nicola visited her doctor, who referred her to the Red Cross’s skin camouflage service.

At the clinic, a Red Cross volunteer spent an hour showing Nicola how to use the camouflage creams, designed to cover disfiguring skin conditions.

Nicola remembered: "I just wanted to give it a try. I hadn't heard of anything I could use – normal make-up didn't hide the scar. After finding the right shade, the volunteer applied the cream for me. She then cleaned it off and I had to put it on myself, while she checked that I was doing it right. I was soon able to do it at home quite easily.

"I apply it every morning now before work – it takes five to 10 minutes to apply. It definitely makes me feel more confident than I did before. I'm looking forward to having an operation soon to correct the worst part of the scar, but when I go out the make-up is really good for hiding it. When I have the make-up on and pull my hair over that side of my face, you almost can't see it at all!"

Common questions about scars

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What is scar tissue?

When the skin is injured, the body produces a protein called collagen in and around the wound to help heal the break in the skin. This build-up of collagen creates a mark on the skin that is known as a scar.

A scar can be a fine line, a pitted hole or an overgrowth of tissue. Although scars are permanent, they can fade over a period of up to two years.

What are the different types of scars?

Many different types of scars can form after an injury, including:

  • normal fine-line scars - minor wounds usually heal to leave a raised line that gradually gets paler and flatter over time
  • keloid scars - some people produce too much collagen after an injury. This creates a lumpy, raised scar that tends to be larger than the original wound, even after it has fully healed
  • hypertrophic scars – when too much collagen is produced at the site of a wound (but not as much collagen compared with keloid scars) you can develop a raised scar that does not extend beyond the boundary of the original wound
  • pitted (atrophic or 'ice-pick') scars – skin conditions, such as acne and chickenpox, or an injury that causes a loss of underlying fat can cause scars with a sunken or pitted appearance
  • contracture scars – these scars are caused by the skin shrinking and tightening, usually after a burn. Contracture scars often lead to tightness and can restrict movement

Do scars fade on their own?

Most scars tend to fade and become paler over time. However, a scar is unlikely to completely disappear.

Some treatments, such as corticosteroid injections and silicone sheets or gels, can help to improve the appearance of some scars. However, their efficacy can depend on the type and age of the scar.

How can I get rid of acne scars?

If you have acne scars you may need specialist treatment, such as:

  • laser resurfacing of the skin
  • mechanical or chemical peeling of the skin
  • breaking the scar tissue down with a sterile needle
  • collagen filler injections

You may be able to prevent acne scars from forming by getting early treatment for acne.

How can I prevent a burn from scarring?

Not all burns leave a scar. Minor burns (in which only the upper layers of skin are damaged) usually heal without scarring, even if the skin has blistered. However, a deeper burn that involves all the layers of skin is more likely to leave a scar.

You can reduce the risk of scarring after the burn has healed by:

  • rubbing an emollient onto the affected skin two or three times a day
  • using high sun protection factor (SPF) sunscreen when you are outside

Does vitamin E help scars?

There is little clinical evidence to support claims that vitamin E can help to heal scars or improve their appearance.

How can I get rid of internal scar tissue?

Internal scar tissue (adhesions) can form as part of the natural healing process after surgery or an infection. Most people do not need any treatment to remove internal scar tissue because it does not usually cause problems.

If you have scar tissue that is causing symptoms, such as pain, speak to your doctor. They may refer you to a hospital specialist for treatment.

Can severe allergic reactions to medicine scar the face?

An allergic reaction to medicine can cause a rash on the face or elsewhere on the body. Most medicine-related rashes go away without scarring once you stop taking the medicine.

In some people, certain medicines can trigger a serious, but rare, adverse reaction called Stevens-Johnson Syndrome. This condition can affect the skin and cause scarring.

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