Scars

About

Scars

What is a scar?

Whenever your skin is injured -- cut, scaped, pierced, or gashed -- your body immediately reacts to repair the damage. The repair work depends on how deep the wound is. If it’s just the top layer of skin, new skin will cover the area after it heals. If the wound goes deeper than the first layer, your body repairs it with tissue thicker than your skin. After the wound is healed, a scar usually develops from that repair tissue. The more repair tissue your body makes, the more raised the scar will be. A sunken scar, from acne or chickenpox, is due to skin inflammation, which destroys the collagen in your skin. Collagen gives skin its structure, smoothness and elasticity. 

Scars can be pinkish to reddish in color, but turn lighter or darker than the surrounding skin over time. Most scars are flat with slightly wrinkled skin on top. Good wound care can minimize a scar or even prevent it from forming. 

Do I need to be concerned about my scars?

Having a scar means the wound has already healed, and there’s not much you can do about it. However, get medical attention for any scar that becomes irritated, oozes or bleeds. If a scar is prominent, or rubs on clothing, you may want to have it treated so it’s less noticeable. The chief concern is that skin cancer can develop in scars, especially scars from a deep or widespread burn.

Causes

What causes scars?

A scar can develop after your body heals a skin injury. Certain skin conditions (acne, chickenpox, epidermolysis bullosa, hidradenitis suppurativa) can also cause scars. A deep injury is repaired when cells quickly make collagen. Because it’s made quickly, the repair collagen is thicker and less flexible than normal skin. It’s this thick, less flexible tissue that forms a scar.

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Symptoms

What are the symptoms of scars?

Scars vary widely in appearance, shape and size. These differences are due to:

  • Cause of the injury
  • Size and depth of the wound
  • Location of wound on your body
  • Wound care after the injury
  • Medications you’re taking
  • Your age, skin color and genes that can affect how skin heals

Scars can feel rough, raised or sunken/pitted. Many scars will fade or shrink over time. As nerve endings that were severed or damaged during the injury grow back, a scar can become itchy or painful. This can happen months or years after the injury. Sometimes skin cancer can look like a scar. If you notice a scar but were not injured, have it evaluated by your doctor right away. 

Are there different types of scars?

Scars can be classified into these types:

  • Flat scars are most common. They can have a pinkish color and be slightly raised when they form, flattening out with time. They can be itchy or painful. Good wound care increases your chances of a less noticeable, flat scar.
  • Raised scars (hypertrophic) are higher than the surrounding skin, but will flatten somewhat over a period of months or years. This type of scar can itch or be painful, and can restrict movement if it forms on an elbow or other joint. 
  • Depressed scars (atrophic) look sunken or pitted and most form on the face. They can become more noticeable with age as the skin relaxes and sags. 
  • Keloid scars rise above the surrounding skin and are much larger than the wound that caused the scar. They can appear months after the skin was injured. Keloids can be itchy or painful, and restrict movement if they form over a joint. Treatment is required to reduce the size of a keloid.
  • Contracture scars limit your movement because the scar tissue is tighter and thicker than normal skin. A moderate to severe burn often causes a contracture scar, and they can develop if a large keloid forms. Contracture scars can extend deeper into the skin and affect muscles and nerves.‍
  • Stretch marks (striae) are also a type of scar because they cause breaks in connective tissue lying beneath the skin. They can occur any time the skin grows or shrinks quickly, such as during pregnancy, rapid weight change, adolescent growth spurts, or bodybuilders who bulk up. At first they can be red, purple or brown, changing to white or silver as they mature. They can be either slightly raised above or lower than surrounding skin.

Diagnosis

Do scars need to be diagnosed?

Yes, if you are considering treatment for a scar. See your dermatologist if it’s irritating the surrounding skin, limiting your movement, oozing, bleeding, or is painful, tender, itchy or looks infected. A new mole or growth near the scar should be evaluated right away for skin cancer. Your dermatologist needs to know your medical history and the type of scar you have to develop an individualized treatment plan. A dermatologist can identify the type of scar you have, advise you if it will fade over time, and develop a treatment plan.

Treatment

Can scars be treated?

Most scars do not need treatment. Treatment can improve the look and feel of a scar; however, a scar will never go away completely. Treatment depends on your age, the type of scar you have and how long you’ve had it. Some treatments can prevent a scar from forming. 

Scar treatment can include: 

  • Dermabrasion removes the top layer of skin with a gentle “sanding,” to soften and smooth the scar and surrounding skin.
  • Injections of medication directly into the scar can reduce its size, make it flatter, and reduce pain and itching. Corticosteroid injections work well with keloids. 
  • Laser or light treatments work well to fade the color of the scar, help flatten it, and reduce pain, itching and tenderness. Laser treatment can prevent scars and keloids, decrease scarring after surgery, and improve mobility. 
  • Pressure therapy uses an elastic bandage or dressing to put pressure on a wound during the healing process. You’ll need to keep pressure on the scar for about a year. Pressure can prevent the scar from forming or make it smaller and flatter. Massage therapy can break up scar tissue and allow it to remodel. 
  • Surgery may be needed to improve the appearance of a scar or to transplant skin (skin graft). Surgery can reduce some scars but smaller scars from the surgery will remain. 
  • Creams and ointments can help make a scar smaller. Silicone gel sheets applied to a scar after the wound closes can keep a scar from forming and are worn continuously for months. Another option is to apply a moist, flexible polyurethane pad to the wound area. It can reduce scarring after surgery, and reduce the size and hardness of raised scars. 
  • Cryosurgery freezes the scar with liquid nitrogen, slowly destroying scar tissue and reducing the size of a raised scar or keloid. It can also help with pain, itching, hardness and discoloration. 
  • Radiation therapy can reduce raised scars and keloids, reduce itching and pain, and reduce the risk of the scar returning after surgery. Radiation is rarely used because of the potential risk of future cancer.

Are there ways to reduce scarring?

Get stitches or special bandages that hold the skin together during the healing process if you have a deep or large wound. Stitches can reduce scarring.

Keep the wound clean with soap and water. Never use hydrogen peroxide because it can further damage skin. Change the bandage as the wound heals.

Use moist burn pads or petroleum jelly to keep the wound from scabbing; scabs make scarring worse.

Avoid the sun because it can darken a scar. 

Pay attention to your diet. Low levels of protein and vitamins D and C can make scarring worse.

References

American Academy of Dermatology Association. (n.d.) Scars: Overview. Retrieved 10-1-21, {https://www.aad.org/public/diseases/a-z/scars-overview}
American Academy of Dermatology Association. (n.d.) Scars: Signs and Symptoms. Retrieved 10-1-21, {https://www.aad.org/public/diseases/a-z/scars-symptoms}
American Academy of Dermatology Association. (n.d.) Scars: Who Gets and Causes. Retrieved 10-1-21, {https://www.aad.org/public/diseases/a-z/scars-causes}
American Academy of Dermatology Association. (n.d.) Scars: Diagnosis and Treatment. Retrieved 10-1-21, {https://www.aad.org/public/diseases/a-z/scars-treatment}
WebMD. (n.d.) Cosmetic Procedures: Scars. Retrieved 10-1-21, {https://www.webmd.com/beauty/cosmetic-procedures-scars#1}
Cleveland Clinic. (March 2021) Scars. Retrieved 10-1-21, {https://my.clevelandclinic.org/health/diseases/11030-scars}

Information

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

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Affordable –
with or without insurance

With Insurance

Dermatology

Your copay
Depending on insurance

Without Insurance

Dermatology

$89

Initial Visit

$75

Follow Up