Scars

  • Overview

    Scars: Overview

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    If you dislike the look of a scar, treatment may make it less noticeable.

    What exactly is a scar?

    When you injure your skin, your body naturally repairs the damage. How your body repairs this damage depends on how deeply the injury penetrates your skin.

    If the injury damages the top layer of your skin, you’ll likely see new skin when the wound heals. To repair damage that goes deeper than the first layer, your body makes a tissue that’s thicker than your skin. This thicker tissue often becomes a scar.

    New scars have a pink to reddish color. As a scar matures, it often turns lighter or darker than your skin.

    Most scars are flat, and the skin on top tends to look wrinkled.

    If your body makes lots of extra tissue, you’ll see a raised scar. Sometimes, the body makes an excessive amount of extra tissue and you see a raised scar that is bigger than the original wound. This type of raised scar is called a keloid.

    You may see a sunken scar if something causes a lot of inflammation in your skin, such as acne or chickenpox. This happens because the inflammation destroys collagen in your skin. This type of scar tends to appear when acne or chickenpox heals.

    The right wound care can prevent or lessen some scars

    How you care for a wound affects how your skin heals. With the right wound care, it’s possible to minimize scarring. Sometimes, you can prevent a scar from forming.

    When caring for a wound, it’s important to keep it clean. When cleaning a wound, use soap and water. Never use hydrogen peroxide, which can further damage your skin.

    It’s also important to get stiches when you need them. This can help your skin heal and lessen scarring.

    To find out how to care for minor wounds, go to Proper wound care: How to minimize a scar.

    A scar increases your risk of getting skin cancer. Reduce your risk by covering scars with clothing or a broad-spectrum sunscreen that has SPF 30 or higher. Apply daily.

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    Treatment can make a scar less noticeable

    If you develop a scar, it may become less noticeable over time. Some scars, such as keloids and sunken acne scars, don’t fade.

    Not every scar requires treatment. You may want to consider treatment if a scar makes you feel uncomfortable. Treatment can reduce symptoms, such as pain and itch. When a scar reduces your ability to move, treatment can often help you regain some movement.

    A board-certified dermatologist can tell you what type of treatment may diminish your scar. Treatment varies for each type of scar.

    Images
    Image 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    Image 2: Getty Images

    References
    Garg A, Levin NA, et al. “Approach to dermatologic diagnosis.” In: Wolff K, et al. Fitzpatrick’s dermatology in general medicine (7th edition). McGraw Hill Medical, USA, 2008:27.

    Gold MH, McGuire M, et al. “Updated international clinical recommendations on scar management: Part 2—Algorithms for scar prevention and treatment.” Dermatol Surg. 2014;40(8):825-31.

    Stier MF, Hirsch RJ. “Rejuvenation of scars and striae.” In: Hirsch RJ, et al. Aesthetic rejuvenation. McGraw Hill Medical, China, 2009:210-24.

    Tziotzios C, Profyris C, et al. “Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures.” J Am Acad Dermatol. 2012;66(1):13-24.


    Scars
  • Symptoms

    Scars: Signs and symptoms

    Scars come in many shapes and sizes. If you have two or more scars, you may notice that the two scars look very different. This happens because so much affects what a scar looks like, including the:

    • Cause (accident, acne, burn, surgery, etc.)
    • Wound (size and how deeply the wound penetrated your skin)
    • Body part (where you wounded your skin)
    • Wound care (how you treated the wound)

    Your genes, age, skin color, and the medications you take can also affect how your skin heals.

    Types of scars

    When a scar forms on the skin, it will be one of the following types.

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    Most scars, such as the one on this man's skin, are flat.

    Flat scar

    Medical name: Cicatrix (sick-ah-tricks)

    What it looks like: While you will eventually see a flat scar, when this scar first appears it tends to be pink to reddish in color and slightly raised. It may also be itchy or painful.

    As your skin continues to heal, the scar will flatten and change color. In time, many flat scars are nearly the same color as your skin. A flat scar may also be paler or slightly darker than your surrounding skin.

    Proper wound care may increase the likelihood that you’ll see a flat scar instead of a raised scar.

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    A raised scar appeared on this man's chest after surgery.

    Raised scar

    Medical name: Hypertrophic (hi-per-tro-fic) scar.

    What it looks like: This scar rises above the surface of your skin, so you see a raised, firm scar.

    Over time, raised scars tend to flatten, but flattening can take months or years. A raised scar is most likely to form on the chest, upper back, or shoulder area, but it can appear anywhere on your skin.

    Some raised scars itch or feel painful. If the scar is large or forms on a shoulder, elbow, or other joint, it can restrict your movement. If you experience any of these problems, you should see a board-certified dermatologist. Treatment can relieve these complications.

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    These deep scars, called icepick scars, appeared when severe acne cleared.

    Depressed scar

    Medical name: Atrophic (a-tro-fic) scar

    What it looks like: These scars sit below the surface of your skin, giving the skin a sunken or pitted look. Most depressed scars form on the face.

    Sunken scars can become more noticeable as you age. This happens when the skin relaxes and sags, causing the depressions to become more noticeable.

    You’re more likely to develop depressed scars after chickenpox or severe acne clears.

    Depressed scars are so common after severe acne clears that dermatologists divide these acne scars into these 3 types:

    • Boxcar acne scar
    • Icepick acne scar
    • Rolling acne scar

    Separating acne scars into distinct types allows a dermatologist to treat each a bit differently, which gives patients the best results.

    scars-keloid-ear.jpg
    The mass on this girl’s earlobe is a keloid, which appeared several months after she had her ears pierced.

    Keloid

    Medical name: Keloid (key-loid)

    What it looks like: This scar rises above the surface of the skin. Unlike other raised scars, keloids grow much larger than the wound that caused the scar.

    A keloid may appear months or even a year after you injure your skin.

    As a keloid grows, it may feel painful or itchy. Like other raised scars, a keloid can reduce your ability to move if it forms over a joint, such as the shoulder or elbow, or grows very large. Treatment can help ease these complications.

    While flat and raised scars may eventually become less noticeable, keloids never go away without treatment.

    scars-contracture.jpg
    After a blast injured this man’s arm, he developed this contracture scar, which limits his ability to move his wrist, forearm, and fingers.

    Contracture scar

    Medical name: Contracture (con-trac-ture) scar

    What this scar looks like: When a scar forms, the new tissue tends to be tighter and thicker than your skin. Sometimes, this tightening makes it difficult to move. Any scar that limits movement is called a contracture scar.

    Burns, except for minor ones, often cause a contracture scar. A contracture scar on your knee may mean that you’ll no longer be able to fully straighten your leg.

    Because a contracture scar can restrict movement, it is a serious complication.

    If you have a serious burn, go to a burn center. Getting treatment at a burn center can help you prevent a contracture scar.

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    You can also develop a contracture scar if a large keloid forms.

    scars-stretch-marks.jpg
    Any time your skin expands quickly, such as during pregnancy, you can develop stretch marks.

    Stretch marks

    Medical name: Striae (stry-ā)

    What this scar looks like: Yes, stretch marks are a type of scar. Stretch marks are scars because they cause breaks in our connective tissue (the tissue that lies beneath our skin and gives it shape).

    We typically get stretch marks when our skin grows or shrinks quickly, such as during pregnancy, rapid weight loss or gain, or adolescence. Bodybuilders and weight lifters who bulk up quickly can also develop stretch marks.

    Early stretch marks are often red, purple, or dark brown. As stretch marks mature, they lighten and tend to look white or silver. Stretch marks can be slightly raised or sit a bit lower than the surface of your skin.

    Images
    Images 1, 6: Getty Images

    Images 2,3,4,7: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    Image 5: Used with permission of the Journal of the American Academy of Dermatology. J Am Acad Dermatol. 2014;71:841-2.

    Reference
    Gold MH, McGuire M, et al. “Updated international clinical recommendations on scar management: Part 2—Algorithms for scar prevention and treatment.” Dermatol Surg. 2014;40(8):825-31.


    Scars
  • Causes

    Scars: Who gets and causes

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    When you injure your skin, a scar can form after the wound heals.

    Who gets scars?

    Nearly everyone gets at least one scar.

    You may have gotten a scar from a burn, cut, or scrape. Many people see a scar after having surgery.

    Some skin conditions can cause a scar. If you had chickenpox or severe acne, scars may have appeared as your skin cleared.

    Epidermolysis bullosa (EB), a rare skin disease, can cause scars. EB makes the skin extremely fragile, so it blisters easily. As the blisters heal, scars often appear. Another skin disease, hidradentis suppurativa, can cause deep wounds in the skin. As these wounds heal, scars appear.

    If a type of scar called a keloid runs in your family, you may develop these raised scars easily. Some people develop a keloid after having their ears pierced or getting a tattoo.

    What causes a scar?

    A scar forms on your skin when your body heals an injury. To get a scar, the wound has to go deep enough to injure the inner layers of your skin, the dermis.

    When we injure the deeper layers of our skin, cells make collagen to repair the wound. Because your body makes this collagen quickly, it’s thicker and less flexible than the rest of your skin. The thicker, less flexible tissue is a scar.

    References
    Gold MH, McGuire M, et al. “Updated international clinical recommendations on scar management: Part 2—Algorithms for scar prevention and treatment.” Dermatol Surg. 2014;40(8):825-31.

    Tziotzios C, Profyris C, et al. “Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures.” J Am Acad Dermatol. 2012;66(1):13-24.


    Scars
  • Treatment

    Scars: Diagnosis, treatment, and outcome

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    Many scars can be treated if they make you feel uncomfortable around others, cause pain, or restrict your movement.

    Why should a dermatologist diagnose what type of scar you have?

    While it may seem obvious that you have a scar, it’s important to have a dermatologist examine it before it’s treated.

    Scars are complex. To treat you safely and effectively, it’s important for the person treating you to know about your health and the type of scar you have.

    Different types of scars require different treatment. Your age and how long you’ve had the scar may also affect the types of treatment that will work best for you.

    A board-certified dermatologist has the training and experience required to tell you:

    • What type(s) of scar you have
    • If a scar is likely to fade with time
    • When to treat the scar to get the best results
    • What treatment is recommended

    It’s also important to have a dermatologist examine your scar because sometimes skin cancer can look like a scar. If you see a scar on your skin and don’t remember injuring your skin, immediately make an appointment to see a board-certified dermatologist.

    Another good reason to see a dermatologist before having a scar treated is to make sure it’s still just a scar. Sometimes, skin cancer develops in a scar. You can reduce this risk by always wearing sunscreen when clothing won’t cover your scar. To give you the protection you need, always use a broad-spectrum sunscreen with SPF 30 or higher.

    You also want to avoid tanning beds, which increase your risk of developing skin cancer.

    How do dermatologists prevent and treat scars?

    The treatments described on this page apply mainly to raised scars and keloids. You’ll find information about treating other types of scars on these pages:


    If you have a raised scar or keloid, your dermatologist may recommend one or more of the following treatments.

    Pressure therapy: Applying pressure to a wound while it’s healing can:

    • Reduce (or prevent) a scar, especially while a burn heals
    • Prevent a keloid if your skin tends to form this type of scar
    • Prevent a keloid from returning after it’s surgically removed

    To apply pressure, a patient wears a pressure dressing, which may be an elastic bandage, stocking, or earring.

    Some patients find the pressure dressing uncomfortable and stop wearing it too soon. To get results, however, you may have to wear the pressure dressing for as long as one year. You may also need to get a new pressure garment every 6 to 8 weeks.

    If you have a wound on your face, pressure therapy is not a treatment option.

    Silicone gel (sheet or ointment): Used since 1982, silicone can:

    • Treat a raised scar by reducing its size, hardness, redness, swelling, itch, or stiffness
    • Prevent a raised scar, especially after surgery
    • Prevent a scar from developing after surgery to remove the scar

    Studies show that the silicone gel sheets appear to work better than the silicone ointment.

    The gel sheets are thin and self-adhesive. You use them after the wound closes. To get results, you must wear a gel sheet every day — often for months. Having this in the same spot every day can cause side effects. The skin can breakdown. Some people develop a rash.

    If side effects occur, tell your dermatologist. You may need to stop wearing the sheeting and use another treatment.

    Polyurethane dressing: This is a moist, flexible pad. You wear it to:

    • Reduce scarring after surgery
    • Treat a raised scar by reducing the color, hardness, and size

    When worn for 6 weeks after surgery, it may prevent a raised scar. Studies have shown that patients who wear a moist dressing with a pressure garment get better results than patients who use one or the other.

    Lasers and other light treatments: This is becoming the go-to treatment for all types of scars because these treatments can:

    • Prevent raised scars and keloids
    • Reduce the appearance of existing raised scars and keloids
    • Decrease scarring after surgery
    • Treat some depressed acne scars
    • Lessen the color of the scar, such as redness
    • Increase a person’s ability to move when a scar limits movement
    • Reduce pain, itch, hardness, and swelling

    Studies show that laser therapy or pulse-dye light can give patients impressive results. In the skilled hands of a board-certified dermatologist, these offer patients a safe treatment option with few side effects.

    To give patients the best results from laser or light treatments, a dermatologist may also inject a medication, such as corticosteroids or 5-FU, into the scar.

    For more information on laser treatment for scars, go to 10 things to know before having laser treatment for your scar.

    Corticosteroid injections: Widely used to treat raised scars and keloids, dermatologists inject a corticosteroid directly into the scar to:

    • Reduce the size of a raised scar or keloid
    • Ease symptoms of itch and pain

    Studies show that it can reduce the size of a scar by 50% or more. In some cases, it can look like the scar is completely gone.

    To get results, most people need more than 1 treatment.

    Possible side effects include the scar returns, thinning skin, and dark spots where you had the injection.

    To reduce possible side effects, you may receive another scar treatment, such as an injection of 5-FU or treatment with a pulsed-dye laser.

    5-FU or bleomycin injections: Your dermatologist may inject one of these medications directly into the scar to:

    • Reduce (or completely flatten) a raised scar or keloid
    • Ease symptoms of itch and pain

    Possible side effects include redness, swelling, thinning skin, or dark spots where you received the injection.

    To reduce these possible side effects, a patient often receives another scar treatment, such as a corticosteroid injection or pulsed-dye laser therapy.

    Cryosurgery: This treatment freezes the scar, which slowly destroys the scar tissue. Dermatologists have used this treatment for years to:

    • Reduce the size of raised scar or keloid
    • Reduce pain, itch, hardness, and discoloration

    After one treatment, the freezing can reduce the size of a scar by 50% or more.

    To reduce the size of a scar even more, a patient may also receive an injection of a medication, such as corticosteroid or 5-FU.

    Scar surgery: During this treatment, a dermatologic surgeon cuts out the scar. In the hands of board-certified dermatologic surgeon, scar surgery can:

    • Reduce the size of a keloid
    • Increase your ability to move if a scar limits movement

    While surgery can be effective, it is usually only an option when other treatment fails. A scar can return after it’s removed. To reduce the risk of this happening with a keloid, the surgeon often leaves the border of the keloid in place.

    To improve results, another treatment, such as injections of a corticosteroid, is often given to patients who have scar surgery.

    Radiation: Studies show that radiation therapy can:

    • Reduce raised scars and keloids when other treatments fail
    • Relieve the itch and discomfort that sometimes occurs in raised scars and keloids
    • Lessen the risk of a scar returning after scar surgery

    Very few patients receive radiation therapy because there is a concern that it can cause cancer years later. Other possible side effects include dark spots, itch, redness, and swelling.

    Other treatments for scars: You'll find non-prescription scar treatments that contain ingredients such as onion extract, vitamin A, and vitamin E. Research on how well these work is limited. Before using one of these, the AAD recommends that you speak with a board-certified dermatologist.

    Will my scar go away?

    Many scars will fade without treatment. Keloids and depressed (sunken) acne scars, however, won’t fade. As you age, depressed acne scars tend to become more noticeable as your skin loses its firmness.

    Treatment can help fade scars more quickly. If you have a keloid or depressed acne scar, treatment can make it less noticeable.

    Although treatment can help, it’s always best to prevent a scar whenever possible. The right wound care can reduce your risk of getting a scar or make a scar less noticeable.

    You can learn how to care for a wound at: Proper wound care: How to minimize a scar

    Images
    Image 1: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

    Image 2: Getty Images

    References
    American Academy of Dermatology. “Scar treatment can help improve patients’ quality of life.” News release issued July 28, 2016. Last accessed November 14, 2017.

    Tziotzios C, Profyris C, et al. “Cutaneous scarring: Pathophysiology, molecular mechanisms, and scar reduction therapeutics Part II. Strategies to reduce scar formation after dermatologic procedures.” J Am Acad Dermatol. 2012;66:13-24.

    Zurada JM, Kriegel D, et al. “Topical treatments for hypertrophic scars.” J Am Acad Dermatol. 2006;55:1024-31.


    Scars