Scars

Scar formation is a natural part of the skin’s healing process whereby the body tries to repair damage, producing fibrous tissue called a scar. Scars are composed of collagen, the same material present in healthy skin, but in scars these fibres usually align in one direction rather than the random basket-weave pattern that gives normal skin its suppleness and strength. As well, scar tissue also does not re-grow sweat glands and hair follicles. They are often depressed, elevated, pink, red or shiny and can cause itching, tenderness, pain and a decreased range of motion.

Two common types of scarring seen in the skin are hypertrophic and keloid scarring, both of which are caused by excess collagen growth during the healing process, resulting in a firm, raised, purplish/red scar. Hypertrophic scars result in a raised scar compared to the surrounding skin. Keloid scars are hypertrophic scars which grow larger and outside the original wound area, and can occur in anyone but most commonly in dark-skinned people. 

There are certain factors that increase the likelihood of hypertrophic and keloid scars which include age, location of trauma, nature of the injury, patient race and surgical technique, all of which play a role in the development of hypertrophic and keloid scarring. Such scars are more common in young adults and are more likely to occur on scars on the chest, shoulders, back and jawline areas. Hypertrophic/keloid scars are more common in Asians and dark skin types and are also more common in acne patients, burn injuries and surgical excisions.

Hypertrophic Scars

Hypertrophic and keloid scars are more common if poor surgical technique is initially performed. To reduce the incidence of these scars it is essential that wounds be orientated correctly at the time of surgical removal of a lesion, that tension is reduced and special non-reactive sutures are placed within the wound.

Keloid Scars

Keloids can be caused by acne, body piercings, surgery, tattoos or any injury or inflammation of the skin. Keloids are much more common on the chest, shoulders, upper back, arms and ear lobes and also tend to itch and be painful. A combination of treatments produce the overall best result, including silicone sheeting applied to the scar, injections of intralesional steroid/Five Fluorouracil, pulse dye laser treatments and fractionated CO2.