Scars are a natural part of the body's healing process. A scar results from the biologic process of wound repair in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring.
Scars can result from accidents, diseases, skin conditions such as acne, or surgeries.
How Do Scars Form?
Scars form when the dermis (deep, thick layer of skin) is damaged. The body forms new collagen fibers (a naturally occurring protein in the body) to mend the damage, resulting in a scar. The new scar tissue will have a different texture and quality than the surrounding tissue. Scars form after a wound is completely healed.
There are different kinds of scars. Most scars are flat and pale. However, in cases when the body produces too much collagen, scars can be raised. Raised scars are called hypertrophic scars or keloid scars. Both of these kinds of scars are more common in younger and dark-skinned people.
Some scars can have a sunken or pitted appearance. This kind of scarring occurs when underlying structures supporting the skin (for example, fat or muscle) are lost. Some surgical scars have this appearance, as do some scars from acne.
Scars also can appear as stretched skin. Such scars result when the skin stretches rapidly (for example, as in growth spurts or during pregnancy). In addition, this type of scar can occur when the skin is under tension (near a joint, for example) during the healing process.
How Can Scars Be Treated?
Although scars cannot be completely removed, their appearance can be improved to some extent. Methods for improving the appearance of scars include:
- Topical treatments, such as vitamin E, cocoa butter cream, and several commercial skin care products like Vaseline and Aquaphor that are sold over the counter may be somewhat effective in helping to heal scars.
- Surgery. Although it will not remove a scar, surgery can be used to alter a scar's shape or make it less noticeable. Surgery is not recommended in cases of hypertrophic or keloid scarring (raised scars) because there is a risk of recurring scars as well as more severe scarring that results from the treatment.
- Steroid injections. A course of steroid injections into a scar may help flatten it. Injections may help to soften the appearance of keloid or hypertrophic scars. 5-fluorouracil (5-FU) or bleomycin can be injected into scars to reduce the size of the scar and ease itchiness and pain.
- Radiotherapy. Low-dose, superficial radiotherapy is used to prevent recurrence of severe keloid and hypertrophic scarring. This treatment is used only in extreme cases because of potential long-term side effects.
- Dermabrasion. This treatment involves the removal of the surface of the skin with special equipment. Dermabrasion is useful to blend in the irregularities of a scar whether it is raised or depressed.
- Microdermabrasion is a much less invasive form of dermabrasion but is minimally useful for very superficial scars.
- Laser resurfacing. This procedure, similar to dermabrasion, removes the surface layers of the skin using different types of lasers. Newer types of lasers may achieve more subtle results by working on the collagen in the dermis without removing the upper layers of skin. This advancement results in little down time as opposed to traditional laser resurfacing and dermabrasion, which requires a longer recovery.
- Filler injections. These treatments can be used to raise sunken scars to the level of surrounding skin. The effects of these injections are only temporary, however, and the procedures may need to be regularly repeated. Newer forms of injectable fillers are now on the market and may be an option for some people.
- Microneedling. Many small puncture holes are made into the superficial skin to stimulate collagen production and even introduce collagen stimulators or other products to try to reduce the appearance of scars.
- Cryosurgery freezes the scar to reduce the size of the scar, and reduce pain, itchiness, hardness and discoloration. This may be combined with steroid or 5-FU injections.