A scar is a permanently visible defect, usually of the skin, which remains after healing of a wound. Scars can be caused by accidents, surgery and even diseases. They are a natural part of the healing process of the skin. Scars appear as the wound heals and the skin restores.
Cause
Scars arise when the skin recovers after a skin damage as a result of an accident, surgery or skin disease. If only the epidermis has been damaged, no scars will occur. The more the skin is damaged, the longer the healing process will take and the greater the chance that a scar arises. Scars are formed by scar tissue that is largely made up of connective tissue (collagen).
A scar arises in the so-called proliferation and remodelling phase of the wound. During the proliferation phase, new tissue is created, which is necessary to fill the resulting wound hole. New connective tissue is created for the development of the new skin. This creates a reddish, possibly raised scar. During the remodelling phase, this connective tissue is restructured. When the healing process is going well, the scar will level off, the redness disappear and the scar eventually fade.
Symptoms
The following signs and symptoms may occur with scars:
- The scar becomes larger, thicker or higher.
- The red, dark color doesn’t go away and the scar doesn’t level off.
- There is itch, pain or irritation of the scar.
- The scar gets hard.
- The scar hinders the movement of a particular joint.
Visible but also less visible scars can be a cosmetic problem and sometimes have a negative effect on self-confidence. Scars can be classified into five types: mature, immature, hypertrophic (red, swollen), keloid (overgrowth) and atrophic (dent, pit).
Diagnosis
The diagnosis of a scar is made based on the medical history, the story of the patient and the symptoms. Also physical examination is performed. Upon examination of a scar tissue sample under the microscope, obtained by skin biopsy, can be seen in detail how the connective tissue fibers in the scars are arranged and divided. There is often excessive deposit of collagen and fibroblasts, the connective tissue cells that produce collagen.
Treatment
An ugly scar can be cut out by a plastic surgeon and attached without tension. This scar is often radiated after the operation in order to prevent keloid development again. There are agents on the market which can be used by people themselves to make the scar less visible. There are often silicones processed in these agents. Silicones are used in order to soften scar tissue, to level off and to make the scar smoother.
Symptoms such as pain, itch or discoloration may reduce by silicones. Silicones can be applied to the scar in different ways. There are wound dressings (silicone plasters or sheets) or they are incorporated into a gel or spray. Small hypertrophic and keloid scars and scars in the face can be treated with silicone gel. For large scars, there is also a spray on the market. The advantage of a gel or spray is that it can be used at home. People can apply it themselves and it’s painless. The treatment lasts a minimum of two months.
Prognosis
Existing scars up to about two years old can be well treated. However, it’s better to prevent a scar as much as possible, by starting treatment immediately after an operation, after the wound is closed, before a scar actually arises.
The worse the skin is damaged, the longer it takes to heal and the greater the chance of a visible scar. It usually takes twelve to eighteen months before a scar levels off and fades. However, there are scars that don’t fade on their own.
