Understanding Scarring
After any injury, the body has to heal and the skin has to repair; scarring is a natural part of this process.
Regardless of race and ethnicity, everyone scars but there can be differences in the way the body heals itself In this series we will be looking at how scarring forms, the factors that influence their appearance and what you can do to minimise the impact of scarring on your skin.
What are scars?
A scar is a discoloured mark or an area of fibrous tissue that develops after an injury happens within the skin. The type of scar that is formed and its appearance is determined by your individual wound healing process. However, this is also impacted by:
Age
Ethnic background
Genetics
Hormonal imbalances
Illness and disease
Infection
Nutrition
Lifestyle factors (e.g. smoking)
Medication
Management of injury/wound
Types of scars
The following types of scarring can occur on the face and/or body:
Hypertrophic Scars
Hypertrophic Scars are thickened scars that form due to excessive production of collagen after an injury. They develop within the boundary of the original wound and regress in time. Hypertrophic scars can form after burns, piercings, cuts and in some cases acne and will occur in places where the body holds the most tension such as the chest, earlobes, shoulders, upper back and arms.
Keloids
Keloids develop when the skin is injured and scar tissue forms in order to protect the wound. They often develop spontaneously and continue to grow over the years extending past the site of the original injury.
In appearance, keloids are firm and smooth, either being skin-coloured or dark brown. Similar to hypertrophic scarring, keloids are also more likely to occur on areas of the skin that have the most tension including chest, earlobes, shoulders, upper back and arms. Black people are more susceptible to keloid scarring and are 15 times more likely to experience keloids than white people.
Both types of scars are often benign and harmless but can be itchy and/or tender and may affect movement of the skin in the area.
Atrophic scarring
Atrophic scars classically appear as depressions of the skin and can occur anywhere on the body after any type of trauma. Though, they are commonly seen on the face after illnesses like acne and chicken pox.
The trauma or injury causes the skin to loose collagen, fat and muscle and this results in loss of volume. On the surface of the skin this looks like irregular, pitted and sunken scars that can extend far deeper into the layers of the skin.
There are three main types of atrophic scarring to note:
Ice pick (narrow, with sharp borders, v-shaped)
Box scar (round borders, oval/U-shaped)
Rolling (irregular, undulating appearance and is the most common form of atrophic scarring)
Hyperpigmentation
Hyperpigmentation is a discolouration of the skin that is a very common concern in black and brown skin tones. Post inflammatory Hyperpigmentation is the result of trauma, irritation and injury to the skin stimulates the over production of melanin pigment to the area.
Additionally, hyperpigmentation can be the result illness and medication, which can cause discolouration all over the body.
Hypopigmentatation
Hypopigmentation is caused when the melanin cells (melanocytes) are damaged after an illness, injury or after trauma to the skin and they are unable to regenerate and re-pigment during and after the healing process. In cases where there’s chronic, widespread hypopigmentation (e.g. vitiligo) the cause is usually present from birth or caused by an infection or disease that must be managed.
Contracture
These are often caused by burns and they form after the wounds have completely healed. Contraction occurs when there is a complete reduction in the amount of skin tissue that is rebuilt and repaired due to loss of tissue after injury.
This form of scarring can severely affect quality of life as they can result in long-term pain and disability if not treated.
Striae (Stretch Marks)
Stretch marks develop when the skin stretches or shrinks quickly. These rapid changes damage collagen and elastin fibres which are the scaffolding and support structures of the skin and affect the way they sit within the skin. Although men can get stretch marks, they are more common in women.
Stretch marks affect the abdomen, buttocks, thighs, breasts, back, underarms and groin and occur due to hormonal changes, pregnancy, pubertal growth spurts and weight gain.
Try as we may, scarring isn’t something that can be prevented as most trauma to the skin, no matter how minimal, will result in some form of scarring. Prioritising the health of your skin on a daily basis will go a long way in helping your skin recover after any injury. After trauma skin will also recover well if is kept clean, protected, free from heat and infection and hydration is maintained because this is key for optimal wound healing and to help reduce scars.
Using results driven skincare and having in-clinic treatments will further support the skin and refine any scars left behind, but is it best to seek the advice of a skin practitioner as early as possible to enable the best chance of minimising your scar.