Any interruption of the skin, whether from a fall on the ground, an accident on the job, or from the surgeon’s knife, prompts the complicated and not yet fully understood process of healing, the end result of which is a scar. However, the word “scar” often invokes the image of an unwanted deviation of the healing process, that which is a physical derangement from the smooth and non-discolored appearance of skin that it replaces.
As do the injuries from which they result, the appearance of scars can vary tremendously. Differing scar appearances are because the scars are different from each other. Different scar types are treated differently! Like all of medicine, successful treatment is based on establishing the diagnosis first. The wrong treatment method on a scar results in not only no beneficial effect but a waste of your time and money.
Hypertrophic scars appear as raised, wide, firm, and red to purple-colored scars that
remain within the physical boundaries of the original skin injury. They are more likely to
occur in wounds that cross natural lines of skin tension or an original open wound that
healed on its own. These can cause some itching and discomfort to the touch but may
improve with time.
Keloids are also raised, reddish-purple, nodular scars that are usually firmer than
hypertrophic scars. Keloids are the result of uncontrolled scar healing that the body does
not stop once the wound is healed. The difference between keloids and hypertrophic scars
is that keloids extend beyond the boundaries of the original injury site, encroaching upon
surrounding uninvolved healthy tissue. Keloids can result from seemingly innocuous
activities such as ear piercing and tattoos and unlike hypertrophic scars, keloids do not
regress over time. While keloids can occur in all skin types, they are generally more
common in darker skin.
Stretch Marks are linear bands of wrinkled skin that most frequently result from rapid
weight loss or weight gain, for example following pregnancy, and tend to appear in areas
like the abdomen, breasts, thighs, and hips. Initially, they tend to be red or purple, but
often fade to white over time. They are essentially ‘partial tears’ on the underside of the
kin from overextension.
Depressed Scars (atrophy) are due to the irreversible damage of the skin from the injury
where the amount of scar formed is less thick than that of the surrounding normal skin.
The level of the scar (thickness) is less than that of the surrounding skin. They can occur
from a multitude of inciting events such as acne lesions, burns, or skin avulsive injuries
from trauma. Trying to apply makeup to conceal depressed scars actually worsens their
appearance as makeup enhances the textural variations.
Acne scars are a variety of depressed scars that have occurred due to loss of skin
thickness from the body’s inflammatory response to a plugged sebaceous follicle. The
inflammatory reaction (infection) results in thinning of the skin even though scar tissue
has formed. Acne scars appear in a variety of shapes, which are important to distinguish,
as they are often treated differently.
Icepick scars are usually narrow, sharply demarcated tracts that are wider at the
surface and taper as they extend through the skin.
Rolling scars are more superficial, wider, and produce an uneven appearance in
The skin.
Boxcar scars are round- to oval-shaped skin dimples with sharp margins and are
wider than icepick scars. Most tend to have diameters from 2.0 - 4.0 mm.
Burn Scars are unique in that they have a very thin and atrophic underlying dermis. They
are quite stiff and inflexible and do not heal well when cut and sutured. The fat layer
underneath them is frequently gone or thinned due to the initial heat of the original injury.
The burn scar can appear smooth and almost ‘glass-like’.
Scar diagnosis is critical to selecting the proper scar revision approach. These simple
descriptions may help one better describe and identify their scar problem.
Dr. Barry Eppley
www.eppleyplasticsurgery.com
Indianapolis, Indiana