- Signs & Symptoms
What is a scar?
Scarring is the process by which wounds are repaired. Damage to the deeper layer of the skin, the dermis, is required to produce a scar. Damage to only the epidermis, the most superficial layer of skin, will not always produce a scar.
Scars produce a structural change in the deeper layers of the skin which is perceived as an alteration in the architecture of the normal surface features. It is not just a change in skin color.
Fetal tissues and mucosal tissues can heal without producing a scar. Understanding how and why this is possible could lead to better surgical scar outcomes.
What are the different types of scars?
There is only one type of scar. The appearance of a scar depends on the nature of the wound that produced the damage, the anatomical location of the wound, and a variety of genetic factors that are different for each individual.
A defective healing process can result in a keloid, an unsightly, itchy, thick, red, knobby bump that often continues to enlarge over time. Keloids often are larger than the margins of the original wound.
What causes a scar?
The normal healing process in human tissue results in a scar. Scars occur when tissues have been significantly damaged and repaired. It can occur after physical trauma or as part of a disease process. Poorly controlled wound healing can result in thick, unsightly scars that cause symptoms. Therefore, when wounds are produced surgically, physicians utilize techniques to minimize scarring.
How do healthcare professionals diagnose scars?
Scars are almost always diagnosed by visual inspection. There are several rare situations when it may be necessary to examine scar tissue under a microscope to confirm its true identity. This would require a biopsy of the skin and may require the injection of a local anesthetic.
Sometimes other skin conditions can form in a scar and require a biopsy to be diagnosed.
What is the treatment for a scar?
Since scars are part of the normal healing process, ordinary scars are not treated. Only when superficial scars become cosmetically undesirable do they require treatment. This would include scars in those who are predisposed to develop keloids, as well as scars in anatomical regions known to produce thick scars and scars that produce a significant, unpleasant distortion of adjacent anatomical structures.
Thick scars and keloids often flatten out after injections of steroids directly into the fibrous scar tissue. They can respond to the chronic application of pressure and the application of sheets of silicone rubber. Thick scars can be flattened by dermabrasion, which utilizes abrasive devices to sand down elevated scars.
Certain types of depressed scars can be elevated by the injection of a cosmetic skin filler. Certain types of facial scarring respond well to forms of laser treatments. Occasionally, surgical revision of scars can result in a different scar that is much more cosmetically desirable.
Since it takes about a year for scars to mature, it is frequently prudent to wait before starting any invasive surgical revisions.
Are there any home remedies to reduce scarring?
Good wound care is important in preventing excessive scarring as well as speeding up the healing process. Preventing infection can help prevent unnecessary inflammation which can increase the size of wounds resulting in larger, unsightly scars. It is important to remove crusts (scabs) from wounds gently with a washcloth and soap and water at least twice a day and to keep the wound moist by keeping it covered with petroleum jelly or antibiotic ointment, such as Neosporin.
Assuming the wound is healing normally, it would not be unreasonable to cover the wound site after it is covered by skin (epithelialized) with silicone rubber 24 hours a day for a month or so. There is medical evidence that this can diminish the thickness of scars. Proprietary products of this type can be purchased without a prescription. There is an over-the-counter product (Mederma) that may improve the appearance of scars in the short term (first one to two months) but conclusive evidence of efficacy is lacking. This product relies on an extract of onions.
The judicious use of cosmetic makeup can effectively obscure many scars.
IMAGESBrowse through our medical image collection to see pictures of the most common, and uncommon, skin conditions See Images
What is the prognosis of a scar?
Scars generally improve in appearance over the first year. So considerations for invasive treatments need to be prudently considered before that time. On the other hand, scarring usually involves tissue contraction, so that it is unlikely that scars that pull or twist other anatomical structures, producing unpleasant results, will improve. These should be treated sooner than later.
Is it possible to prevent scarring?
Scarring is an integral part of the healing process. Assuming the wound does not become infected, physicians plan excisions to minimize the cosmetic defects produced by scars. This can be accomplished by orienting the wound in such a way that it will not perturb other structures so that the scar can be camouflaged by hiding in wrinkle lines or near other anatomical structures. It is also important to minimize the tension necessary to close the wound surgically.
Does insurance coverage apply to scar treatments?
Most medical insurance does not cover cosmetic procedures. If scarring has produced a change that is deemed other than cosmetic, it is reasonable to expect coverage, for example, when scarring is the result of trauma. Occasionally, this question may be open to dispute so it can be helpful to have a physician's office intercede with the carrier before performing the procedure.
- CDC Warns of Potentially Fatal Bacterial Illness on U.S. Gulf Coast
- Helping Others as Volunteers Helps Kids 'Flourish': Study
- FDA Approves Pfizer's RSV Shot for Older Adults
- What to Do When Tough-to-Treat Lymphoma Strikes During Pregnancy
- Rate of Pregnant U.S. Women Who Have Diabetes Keeps Rising
- More Health News »
Health Solutions From Our Sponsors
Profyris, Christos, Christos Tziotzios, and Isabel Do Vale. "Cutaneous Scarring: Pathophysiology, Molecular Mechanisms, and Scar Reduction Therapeutics." J Am Acad Dermatol 66.1 Jan. 2012: 1-10.
Top Scars Related Articles
Cupping TherapyCupping is a form of traditional Chinese medicine that aims to improve the flow of qi (energy) in the body. Learn more about the benefits and potential side effects of the various types of cupping.
Cuts, Scrapes, and Puncture WoundsLearn about first aid for cuts, scrapes (abrasions), and puncture wounds, when to see a doctor, if tetanus shots are necessary, and how to spot signs of infection.
FolliculitisFolliculitis is a skin condition that causes small red bumps to form around the hair follicles. Skin bacteria such as Staphylococcus and Pseudomonas may infect the follicles. Treatment involves over-the-counter bacterial washes, topical antibiotics, and/or topical steroids.
How to Make Scars Less VisibleIf you have scars that you’d rather make less noticeable, these tips may help you know what you can try yourself and what may need a doctor’s help.
Itching (Pruritus)Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching including infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Leishmaniasis PictureLeishmaniasis is caused by a parasite that spreads to humans through the bite of infected Phlebotomus sand flies and found in the tropical countries of Central and South America, the Middle East, East Africa, and East Asia. It causes nodules or sores to form on the skin, including the skin of the face. Affected people may have a single lesion or many lesions. Sores heal slowly over months to years and leave scars.
MicrodermabrasionMicrodermabrasion is a skin-exfoliating treatment that may improve the condition of acne scars and fine wrinkles. The skin should feel softer and smoother after microdermabrasion. Side effects may include skin tightness, redness, fine broken blood vessels, and minor bruising.
Mohs Surgery for Skin CancerMohs micrographic surgery is a method of removing skin cancers with a local anesthetic. During the procedure, small layers of skin are removed and examined under a microscope until the skin samples indicate that all the cancer has been removed.
Molluscum ContagiosumMolluscum contagiosum is a skin disease that causes painless pink bumps on the skin. Learn about treatment, home remedies, and other symptoms associated with this viral infection.
MRI (Magnetic Resonance Imaging Scan)MRI (or magnetic resonance imaging) scan is a radiology technique which uses magnetism, radio waves, and a computer to produce images of body structures. MRI scanning is painless and does not involve X-ray radiation. Patients with heart pacemakers, metal implants, or metal chips or clips in or around the eyes cannot be scanned with MRI because of the effect of the magnet.
Photodynamic TherapyPhotodynamic therapy (PDT) is a procedure that treats precancerous cells, in addition to other types of cancer cells. The medical treatment does this with the help of a photosensitizing drug and a light source that activates the applied drug, destroying cancer cells. PDT is approved to treat non-small cell lung cancer, esophageal cancer, and Barrett's esophagus. It treats actinic keratosis, as well as acne, rosacea, skin cancer, sun damage, oily skin, wrinkles, warts, psoriasis, and enlarged sebaceous glands.
Shingles (Herpes Zoster)Shingles, or herpes zoster, is a painful rash caused by the varicella zoster virus. Other shingles symptoms include headache, fever, nausea, and body aches. Treatment focuses on pain management and shortening the duration of the illness with antiviral medications.
Skin Health: How to Get Clear SkinAcne, pimples, zits and blemishes often appear on the face, back, chest, neck, and shoulders where skin has the most amount of oil glands. Few of us are immune to breakouts, but treatments can minimize outbreaks. Follow these 15 tips for a clear complexion and skin.
Before You Tattoo: Types, Safety, and RemovalGet the scoop on tattoo safety, tattoo risks, tattoo care, and what to expect from tattoo removal.