What types of scars are there?
Scars occur after an injury to the skin tissue. The body forms scar tissue to prevent the penetration of foreign bodies and pathogens. However, the scar tissue is often less elastic than the normal dermis. Scars do not contain sebaceous glands or sweat glands and no hair grows on them. Many people see scars as a cosmetic problem that limits their self-confidence. Particularly on the face, neck or arms, conspicuous scars are perceived as disturbing. There are three types of scars:
- Atrophic scars: If the body forms too little new scar tissue, the scar sinks compared to the surrounding tissue. This results in dimples, for example in the case of acne or chickenpox.
- Hypertrophic scars: The tissue on a healed wound bulges upwards due to excessive scarring. The body builds up more connective tissue, especially if the wound is exposed to strong tensile forces. Hypertrophic scars usually appear within six months of the injury. The fibers of this proliferation are arranged in parallel. Sometimes hypertrophic scars disappear on their own.
- Keloids: They often occur on the upper body or neck and on the earlobes. Often there is no obvious direct connection with an injury – a mosquito bite or tiny scratch is enough to trigger this skin growth. It often only grows many months after the injury. Keloids often cause unpleasant itching or pressure pain. They can also swell into thick lumps. Keloids are particularly common in some families and sometimes recur even if they are operated on (recurrence).
A combination of different methods is usually necessary for the treatment of unsightly and disturbing scars. It is individually tailored to each case. It is not always possible to make a scar completely invisible. All these types of scars are benign.
Scars: Causes and risk factors
Scars take time to heal completely. Experts expect it to take six to twelve months, sometimes up to two years, for the redness and sensitivity of the scar to disappear. After this time, the initial itching often disappears. People with a wound healing disorder or burns are particularly at risk from proliferating scars, as are allergy sufferers. The older a person gets, the worse their wounds heal. This is because the elasticity and blood supply to the skin decreases and the fat layers become thinner. On the other hand, children and adolescents are particularly at risk of developing bulging scars because their bodies are geared towards growth and therefore often produce too much new connective tissue. Hormones also appear to play a role.
Keloids are very rare. The darker the skin color, the more frequently keloids occur. People with long-standing acne also have an increased risk of keloids.
Symptoms: Scar becomes thick and red
In the case of atrophic scars, the tissue of the scar contracts. With longer wounds in particular, it is noticeable that the entire area looks sunken in.
However, those affected find the excessive scars (hypertrophic scars and keloids) much more disturbing. Sometimes only a slight, reddened bump can be seen on the skin. Instead of being thin and inconspicuous, the scar bulges broadly over the body. Or – especially in the case of keloids – thick and unsightly lumps form. In the case of hypertrophic scars, only the scar itself is affected. Keloids can occur individually or be distributed over a large area. They are particularly common on the earlobe, chest and upper back.
Scars: Diagnosis with us
If you still have pain or an itchy feeling in the scar a few weeks after an injury or operation, or if the scar becomes noticeably larger, you should visit us. We can assess whether this is a normal wound healing process or a benign skin change. As a general rule, the earlier a proliferating wound is treated, the better the success of the treatment. Intervention is also necessary in the case of functional restrictions – for example, if the scar tissue is pressing on a joint. We can recognize which treatment promises the best success by looking at the scar tissue through a magnifying glass. If a treatment does not work within three to six months, we switch to another alternative. Which one we choose depends largely on the type and location of the scar. Progress should be documented regularly with photos.
Scars: prevention, early detection, prognosis
If you have a larger wound, you should really take it easy during the healing phase. If a surgical incision can heal without traction, the risk of growths is reduced. A surgical technique based on the skin tension lines also plays a role here. At the same time, however, targeted, gentle movement can promote blood flow to the scar tissue, making it more supple and loose. It also helps if you regularly apply silicone creams or silicone gels to the scar from two weeks after the operation. To do this, gently massage the cream or gel into the scar tissue at least twice a day. For scars that have hardened, an overnight ointment dressing may also be useful. Preparations with onion extract can also help as a preventative measure. External compression on a wound, for example with compression stockings or a pressure bandage, supports healing.
In the case of injuries, you should make sure that no dirt gets into the wound. You should always protect scars well from sunlight so that they do not darken.
Despite treatment, a proliferating scar will probably never become completely invisible. But with a variety of treatment methods, we can prevent the annoying side effects such as itching and pain and make the appearance more bearable.
Scars: Treatment with laser, cortisone or surgery
In many cases, the first choice for an exuberant wound is to inject glucocorticoids (cortisone) directly into the scar.