Scars are not all caused by the same cause. Changes in appearance can have a negative impact on body image and confidence. Providers are frequently untrained in detecting and managing these psychosocial disorders. Scar disfigurement can lead to despair and anxiety in patients, particularly in burns.
Development of Scar Tissue
When wounds are approximated with sutures, staples, or other instruments that allow the wound to heal by primary intention. Secondary intention occurs when wounds self-heal through granulation, contraction, and epithelialization from the bottom up. As expected, more superficial wounds are confined inside the epidermal layer and thus heal more quickly. In the case of deeper full thickness wounds, the injury is substantial and requires additional time to heal, resulting in more visible and thicker scarring. Hemostasis, inflammatory, proliferative, and remodeling phases comprise the healing cascade. When an injury occurs, the wounded tissue immediately begins self-repair through a complicated interaction of inflammatory mediators and cells. Collagen fibers mend injured skin and progress the wound toward closure during the remodeling phase. Scar tissue is distinct from skin tissue. There is less flexibility, which can result in tightness, restricted movement, and even pain. Collagen proteins grow in a single direction during the creation of scar tissue, rather than in a multidirectional pattern as they do in healthy skin. Scar tissue matures in 12 to 18 months but never reaches the tensile strength of unwounded skin.
- Atrophic Scars- Scars are sunken or “ride low” and are thinner than the surrounding skin. For example, chickenpox or acne scars.
- Contractures (scar tightening)- Contractures are located over joints. When the scarring gets in the muscles and nerves over a joint, it will make it difficult to move and cause pain.
- Hypertrophic scars- These scars are raised or “ride high” above the skin and are thicker, remaining within the original wound margin at the injury.
- Keloid scars- These scars “ride high” above the skin surface and extends beyond the original wound margin at the injury. Their color is normally a red plaque that forms on tissues after an injury. The location of keloids often appears on the earlobe, breastbone, shoulder, back, and face.
- Traumatic Scars- A significant injury to the skin heals.
- Surgical Scars- Large or deep surgical incisions can take 6-8 weeks to heal. Healing depends on the overall general health and type of surgery.
- Stretch Marks- Skin that has quickly expanded or shrunken, the connective tissues underneath may become damaged causing stretch marks.
Treatment Options for Scar Management
There are some scars that should be left alone. There are at-home treatments to attempt for scars that do require attention when certain patterns occur, and if those do not work, there are other medical procedures that may help minimize the appearance and/or pain. When choosing the appropriate treatment with a professional, consider the scar location, symptoms, and age of the scar.
- Chemical peels
- Fat grafting
- Injected agents or fillers
- Physical therapy
- Scar camouflage
- Scar removal creams
- Scar revision
- Silicone gel
Not all scars are caused by the same injury, and nor or they all painful. Scars can have a physical, psychological, and social impact on patients. Providers should have practical knowledge on how scars can affect a person’s emotional health than making them more prone to the development of depression and anxiety.
The views and opinions stated in this blog are exclusively those of the author and do not reflect iWound, its affiliates, or partner companies.
Future Readings and References
American Academy of Dermatology. https://www.aad.org/public/kids/skin/scars
Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/11030-scars
Ngaage M, Agius M. The Psychology of Scars: A Mini-Review. Psychiatr Danub. 2018 Nov;30(Suppl 7):633-638. PMID: 30439862.
Jagdeo J, Shumaker PR. Traumatic Scarring. JAMA Dermatol. 2017;153(3):364. doi:10.1001/jamadermatol.2016.5232.
Carver, Cheryl. “How Scar Tissue Causes Pain and Tips for Management.” WoundSource, 28 April. 2021, https://www.woundsource.com/blog/how-scar-tissue-causes-pain-and-tips-management