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Scar

A scar results from the biologic process of wound repair in the skin and
other tissues of the body. Thus, scarring is a a natural part of the healing
process. With the exception of very minor lesions, every wound (e.g. after
accident, disease, or surgery) results in some degree of scarring.

Scar tissue is not identical to the tissue which it replaces and is usually
of inferior functional quality. For example, scars in the skin are less
resistant to ultraviolet radiation, and sweat glands and hair follicless do
not grow back within scar tissue, myocardial infarction causes scar
formation in the heart muscle which leads to loss of muscular power and
possibly heart failure. However, there are some tissues (e.g. bone) which
can heal without any structural or functional deterioration.

Scars of the skin

A scar is a natural part of the natural healing process. Skin scars occur
when the deep, thick layer of skin (the dermis) is damaged.

To mend the damage, the body has to lay down new collagen fibres (a
naturally occuring protein which is produced by the body).

This process results in a scar. Because the body cannot re-build the tissue
exactly as it was, the new scar tissue will have a different texture and
quality to the suurounding normal tissue tissue. An injury does not become a
scar until the wound has completely healed.

Most skin scars are of the flat and pale variety, which leave a trace of the
original injury which caused them.

Sometimes the body can over-produce collagen, which results in a scar which
is raised above the surrounding skin, these are known as either Hypertrophic
scars or Keloid scars. Hypertrophic scars take the form of a red raised lump
on the skin, but do not grow beyond the boundaries of the original wound,
and they often improve in appearance after a few years. Keloid scars are a
more serious form of scarring, because they can carry on growing
indefinitely into a tumorous growth. These are caused when the body doesn't
know when to stop producing collagen.

Both hypertrophic and keloid scars are more common on younger and dark
skinned people. They can occur on anyone, but some people have a genetic
succeptibility to these types of scarring. They can be caused by surgery, an
accident, or sometimes by acne.

Altenately, a scar can take the form of a sunken recess in the skin, which
has a pitted appearance. These are caused when underlying structures
supporting the skin, such as fat or muscle are lost. This type of scarring
is commonly associated with acne, but can be caused by chickenpox, surgery
or an accident.

Scars can also take the form of stretched skin. These are caused when the
skin is stretched rapidly (for instance during pregnancy, or adolescent
growth spurts), or when skin is put under tension during the healing
process, (usually near joints). This type of scar usually improves in
appearance after a few years.

Treatments for skin scars

No scar can ever be completely removed, they will always leave a trace, but
their appearance can be improved by a number of means, including:

Simple treatments

Using creams that contain Vitamin E taking vitamin E supplements, or
including plenty of vitamin E in a diet from sources such as wheat germ,
nuts, vegatable oils, eggs and green vegetables, can help speed up the
healing process, and lessen the appearance of any scar afterwards.

Cocoa butter cream can be used to help heal scars, and to prevent the
formation of keloid scars.

Surgery

Any surgical scar removal will always leave a new scar that will take up to
two years to mature. Surgery can never remove a scar but can be used to
alter its allignment or shape to make it less noticeable.

Surgery can sometimes make the scar bigger, but improve its overall
appearance. Surgery can sometimes be necessary to remove a scar on skin near
a joint where it restricts movement.

In the case of hypertrophic or keloid scarring, surgery is not recomended,
as there is a high risk of re-ocurrence of possibly worse scarring following surgery.

Laser Surgery & Resurfacing

An experimental treatment, the safety or effectiveness of which has not yet
been proven.

The redness of scars may be reduced by treatment with a vascular laser. It
has been theorised that removing layers of skin with a carbon dioxide laser
may help flatten scars, although this treatment is still highly experimental.

Steroid injections

A long term course of steroid injections under medical supervision, into the
scar may help flatten and soften the appearance of keloid or hypertrophic scars.

The steroid is injected into the scar itself and very little is absorbed
into the blood stream, side effects of this treatment are minor. This
treatment is repeated at 4-6 week intervals.

Pressure garments

Pressure garments should be used only under supervision by a medical
professional. They are most often used for burn scars that cover a large
area, this treatment is only effective on recent scars.

Pressure garments are usually custom-made from elastic materials, and fit
tightly around the scarring. They work best when they are worn 24 hours a
day for six to twelve months.

It is believed that they work, by applying constant pressure to surface
blood vessels, after a long period of wearing one scars flatten and become softer.

Radiotherapy

Low-dose, superficial radiotherapy, is used to prevent re-occurance of
severe keloid and hypertrophic scarring. It is usually effective, but only
used in extreme cases due to the risk of long-term side effects.

Dermabrasion

Dermabrasion involves the removal of the surface of the skin with specialist
equipment and usually involves a general anaesthetic. It is useful when the
scar is raised above the surrounding skin, but is less effective with sunken scars.

Collagen injections

Collagen injections can be used to raise sunken scars to the level of
surrounding skin. Its effects are however temporary, and it needs to be
regularly repeated. There is also a risk in some people of an allergic reaction.

Other treatments

There are also a number of gel sheets available which are usually made from
silicon or polyurethane, which can help to flatten and soften raised scars
if worn regularly.

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