Scar Skin

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by Dr. Yap Lok Huei


For many of us, scars are a real-life concern. There are many types of scars – chicken pox, cuts and grazes, surgical scar, etc.

Of the numerous myths regarding scars and scar healing, one of the most common is consuming dark soy sauce and food like seafood and eggs can predispose one to scarring. The popular view is that dark soy sauce, when taken, can result in darkening and thickening of scars, and that taking prawns or crab meat can result in scarring. There is no medical evidence to indicate that this is the case, and in the latter, additional protein may actually help wound healing in certain patients.

Why Do We Scar?

Following an injury, the body acts as quickly as possible to patch the wound together. There is increased production of collagen at the site of the wound and numerous strands of fibrous material to draw the edges of the wound together, culminating in the formation of a scar. The scar will go through numerous maturation changes, but the wound will not attain the full strength of the original tissues.


For deep scars and wounds affecting subdermal layers, specialised structures such as hair follicles and sweat glands may be damaged at the initial injury and not return.

Due to the fact that everyone heals differently, the final appearance of a scar will vary from individual to individual. The look of the scar is determined by factors such as skin type, scar location, type of injury, age, and even nutritional intake.

Type of Scar

There are numerous ways to categorise scars, but one fairly simple classification is as follows:

* Common scars – These scars appear inflamed and dark in the beginning, but become flatter and paler over time, resulting in a fine line scar.

* Atrophic scars – These scars cause depressions or indentations below the surface of the skin. Examples are scars from acne or chicken pox.

* Hypertrophic scars – Hypertrophic scars are raised above the surface of the skin. They are characterised by excessive amounts of collagen, but always remain within the boundaries of the wound.

* Keloid scars – Keloids are raised scars that spread beyond the boundaries of the wound. They continue to grow over time and usually recur after excision.

* Scar contractures – Scar contractures often develop when scars cross joints or skin creases at right angles. They often occur following burn injuries.

* Stretch marks (striae) – Stretch marks occur in periods of rapid weight gain (teenage growth spurts, pregnancy) when the body expands faster than the skin covering it, causing internal tears in the dermis. When these tears heal, they form scars that manifest on the epidermis as stretch marks.

On average, each person has 1 to 3 scars on the body. It is estimated that most new scars can be attributed to everyday cuts, grazes, and minor burns (34%). The remaining groups include hospital surgery (20%), trauma (15%), elective surgery (15%), mole removal (6%), and cosmetic surgery (10%).

Healing

Scar healing can be related to ethnic origin due to different levels of skin pigmentation. The rate of problems and problematic scars in Hispanic patients is 5 times higher compared to Caucasian patients. Asians on the other hand, have problem scars 10 times as frequently, while African patients have the highest incidence of problem scars – 20 times compared to Caucasian patients.
Most small scars will become significantly less visible if given enough time to heal. However, for scars that are large, thick, indented, or raised, scar treatment is available to reduce their appearance. While no product can make a scar disappear, current solutions offer an opportunity to improve the scar's appearance.

Some of the methods available for treatment of prominent scars are listed below :

Hydrating treatments such as silicone tape or gel application, or the application of oil-based preparations, can be useful to help scars stay moist and soft. Preparations containing purcellin oil in combination with vitamins A and E, and calendula, have been known to help improve the appearance of scars. This should be used in conjunction with guidance from your surgeon – do make sure that the wounds are fully healed before commencing topical treatments.

Anecdotal reports suggest that moisturising preparations that are oil-based, used in conjunction with gentle local massage, can reduce irritation and tightness of wound scars.

Laser treatment can be used to reduce the redness of scars, and in some instances to reduce the size of prominent scars.

Injectable fillers can be used to elevate sunken scars. The most popular fillers are absorbable substances such as hyaluronic acid.

A more natural approach would be to use the patient's own fat which can be harvested from another part of the body and injected under the scar with less risk of secondary scarring.

Steroid injections can help reduce inflammation and activity in flat and soft raised scars. These are injected locally into the scar, and the risk of side effects in the rest of the body is minimised both by the dosage and by accurately localising the injections into the scar sites only.

Radiotherapy has been used in severe cases to reduce hypertrophic and keloid scar formation, but is less popular as there are significant local tissue effects as well as risks of worsening the scar.

Surgical revision – scars can be cut away and irregular edges realigned. This is suitable for jagged scars as a result of dog bites or shearing type lacerations, but is not recommended for active keloid scars. Meticulous technique and the correct suture materials are essential to avoid recurrence or worsening of the previous scar.

Pressure bandages are most often used for prominent, hypertrophic (overgrown) burn scars. This involves the application of an elastic garment that is worn for the majority of the day, which can exert a continuous elastic pressure on the scar. This can help reduce the prominence of the scars.

Each patient's treatment needs to be individualised depending on the cause and severity of the scar, his ethnic and age group, and his response to treatment. This will improve the chances of success in the management of problematic scarring.

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