Scars : A Basic Guide

What determines whether a cut will turn
into a scar? 

The three main determinants of which cuts turn into scars would be

1. What caused the trauma 

2. How deep is the damage

3. How is it managed 

Are some people more likely to get scars than
others?

Before answering this question it’s good to break down what key features to think of when it comes to scars and then who gets what. When people say the word ‘scar’ very different images come to mind!

There can be 

- inflamed or pink scars : more likely if the cut gets infected or if there are stitches involved

- dark or pigmented scars: more likely in either patients with more pigment in their skin naturally or through excess sun exposure. Also more likely if the cut to the skin is below the knees where circulation is not as good as elsewhere leading to decreased cell turnover. Also more likely in cuts exposed to air that scab over

- raised or firm scars: these can occur for a variety of reasons: some people are genetically predisposed. They are more likely in cuts that get infected or inflamed. Also more likely when cuts occur on chest or shoulders. 

- depressed or pitted scars : more likely in traumatic deeper cuts that affect the soft tissue underneath. 

- stretch scars : more likely in kids because their skin is highly elastic and pulls away from the wound to leave the look of a stretch mark

- lighter colored scars : loss of pigment in a scar can occur for a variety of reasons but more likely when trauma is deeper in layers of skin to affect the pigment

- ‘varioliform’ scars: these are flat but lighter and darker than surround skin. More like him pickers! 

 What is a keloid scar? Who is most likely to get
them? Are they something to be concerned about?
 

Keloids are scars that grow well beyond the boundaries of the original cut and well out of proportion to the injury. These are thought to have a  genetic tendency. 

Keloids are of concern because they are difficult to manage, unsightly, painful,  itchy, and, depending on location, can even restrict mobility. I have taken off enormous keloids and treated them with every available modality. Most common treatment is injecting them with steroids to soften and flatten them. They are inherently difficult to manage because by definition they are an overgrowth of scar tissue in people with a tendency towards overgrowth of scar tissue. To do anything to them runs to risk of more scar tissue! 

For people
who have scars, are there products that can safely help scars
fade, and, more importantly, how can people learn to accept
their scars?
 

If you have a high tendency towards scars, then my best advice is to learn how to optimally manage cuts, trauma and surgical incisions. The best approach is prevention. 

Any open cut or wound should be promptly cleaned, apply a generous amount of ointment (petroleum jelly if it’s a clean wound, antibiotic ointment for infected ones), cover with a nonstick bandage and change daily until healed. Do not expose it to the air to let it scab over! It will run a much higher risk of scarring! Our skin heals in like a purse string from the outside in and the bottom up. It relies on a moist environment through ointment based products to allow the skin cells to migrate across the wound effectively. If it’s a surgical scar, consider using silicone scar sheets for 6 weeks after stitches removed. This pressure sheeting tends to prevent raised hypertrophic or keloid scars. 

We can treat pink scars by laser, raised scars by injections, depressed or puckered in scars by subcision plus or minus fillers, pigmented scars with bleaching creams. Lighter colored scars are tough- we have lots of ways to take color out of the skin but not a lot of ways to put it back in! Sometimes light therapy can work however. 

I think of scars as memories- each one has a story or reminds you of a time. If you don’t like the story with your scar- make up a better story! I always say to my patients considering scar treatment that I could get rid of my chicken pox scars in a heartbeat but I don’t because they remind me of when I was 4 and covered in calamine lotion :) I’ve had them so long they are a part of who I am. If a scar is in a difficult location, symptomatic or draws unwanted attention then talk to your dermatologist! I have tons of tricks up my sleeve to treat them!

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