Scars, including hypertrophic scars and keloids, can be the unwelcome result of cuts, burns, surgeries, or skin conditions. The dark, raised, or discoloured marks can leave us feeling self-conscious. But what exactly causes scars, and how do they differ? In this guide, we will decipher the mystery behind scarring, hypertrophic scars, and keloids.
Scarring occurs when the skin repairs itself after an injury. It is a natural part of healing, but the visibility and appearance can vary widely. Keloids are an aggressive type of scar that extend beyond the original injury site and can be excessively raised and firm. Hypertrophic scars, on the other hand, are raised but stay within the boundaries of the injury.
Understanding the differences between scarring, hypertrophic scars and is crucial for anyone seeking treatment options.
Understanding the causes of scarring
Scarring is a natural response of the body to injury or trauma when the skin is damaged. To heal, the body initiates a complex process to repair the affected area. This involves the formation of new collagen fibres, which are essential for the skin's repair.
The type and appearance of the scar can vary depending on the nature and severity of the initial injury. Superficial wounds, such as minor cuts or abrasions, often heal with minimal scarring, as the skin's natural repair mechanisms can restore the damaged area efficiently. However, deeper injuries that penetrate the skin's layers, such as those caused by burns, surgical incisions, or severe lacerations, can result in more prominent and visible scarring.
The healing process itself can also contribute to the appearance of the scar. When the body's natural healing response is disrupted or impaired, it can lead to the formation of abnormal scar tissue, such as hypertrophic scars and keloids. These types of scars are characterised by excessive or insufficient collagen production, resulting in raised, discoloured, or irregular-shaped markings on the skin.
Differentiating between hypertrophic scars and keloids
Hypertrophic scars are characterised by the formation of raised, thickened, and typically red or pink scar tissue that remains within the boundaries of the original injury site. These scars are the result of an overproduction of collagen during the healing process, causing the scar to appear more prominent and textured than the surrounding skin. Hypertrophic scars are typically more common and can occur in individuals of any skin type or ethnicity. These scars are often sensitive to the touch and can itch. Atrophic scars result from too little collagen, giving the skin a sunken look. These kinds of scars are common with acne or chicken pox, or when the injury has caused a loss of tissue.
Keloids are a more aggressive type of scar that extend beyond the original injury site, forming a raised, firm, painful and often irregularly shaped growth on the skin. Keloids are sometimes described as benign tumours of scar tissue. They are caused by an excessive and uncontrolled proliferation of collagen, which can keep expanding even after the initial injury has healed. Keloids are more common in individuals with darker skin tones and can be challenging to treat, as they have a higher risk of recurrence.
Common misconceptions about scarring
Despite the prevalence of scarring, there are many misconceptions and myths surrounding this skin condition that can lead to misunderstanding and unnecessary anxiety. It is important to address these misconceptions to provide a more accurate and informed perspective on the nature of scarring.
One common misconception is that scars are permanent and cannot be improved or reduced in appearance. While it is true that scars may be more challenging to treat than others, advancements in medical and cosmetic treatments have made it possible to significantly improve the appearance of scars, including hypertrophic scars and keloids.
Another misconception is that scars are solely the result of poor wound care or healing. While proper wound care and management can help minimise the risk of scarring, the formation of scars is a natural and complex process. Scarring is influenced by a variety of factors, including genetics, skin type, and the severity of the initial injury.
Additionally, people believe that scars are a sign of weakness or a flaw in one's appearance. This stigma can lead to feelings of self-consciousness and a lack of self-acceptance. However, it is important to recognise that scars are a natural part of the body's healing process and can be a mark of survival, resilience and strength.
The science behind scar formation
The skin's healing process is a response to injury or trauma. When the skin is damaged, the body immediately initiates the repair of the affected area. The phases of repair include haemostasis (blood clotting), inflammation, proliferation of collagen, and remodelling of the produced collagen.
Hypertrophic scars and keloids are the result of an abnormal wound healing response, characterised by an overproduction of collagen and the formation of dense, fibrous tissue. The exact mechanisms that trigger this excessive collagen production are not fully understood, but it is now understood that inflammation plays a significant role. Certain areas of the body, such as the earlobes, shoulders, and chest, are more prone to these types of scars, due to the higher concentration of collagen-producing cells in these regions.
Treatment options for scars and keloids
There are a variety of treatment options available that can help improve the appearance and reduce the discomfort associated with these skin conditions. New research shows that scar removal should be started early to give you the best result, as soon as 2 weeks after the injury has occurred.
One of the most widely used treatments for scarring is the application of topical silicone-based products, such as gels or sheets. These products work by applying pressure to the scar tissue, reducing inflammation, and promoting the flattening and fading of the scar over time. Silicone-based treatments are often recommended for both hypertrophic scars and keloids, as they can be effective in minimising the raised and discoloured appearance of the scar.
For more stubborn or severe cases, intra lesional corticosteroid injections may be prescribed. These injections, administered directly into the scar tissue, can help reduce inflammation and stimulate the breakdown of collagen, leading to a flattening and softening of the scar. Corticosteroid injections are particularly effective in treating keloids, as they can help prevent the scar from continuing to grow and expand.
Microneedling is also an effective way to reduce scars by encouraging new collagen production. This treatment uses tiny needles to penetrate the skin, causing micro-injuries. This stimulates new healing in the area and can help to make scars appear softer and smoother as a result.
For individuals seeking a more integrated approach, alternative therapies like massage, compression therapy, and the use of botanical oils or creams may also be beneficial in improving the appearance and texture of scar tissue. These treatments can help promote blood flow, reduce inflammation, and soften the scar over time.
Consulting with a dermatologist or plastic surgeon can help determine the most appropriate treatment plan to address the specific needs and goals of the individual.
Preventing and minimising the appearance of scars
There are steps that can be taken to help prevent or minimise the appearance of scars, hypertrophic scars, and keloids.
One of the most important steps in preventing and minimising scarring is proper wound care. Keeping the affected area infection free, moist, inflammation free and protected from further injury can help facilitate the natural healing process and reduce the risk of defective collagen production. The Trifectiv Plus protocol includes the use of our Trifectiv Plus Wound & Burn Care solution combined with woven gauze and breathable dressings to promote optimal healing. Trifectiv Plus has been demonstrated to dramatically reduce scar formation during the healing phase of wound repair. It is important that wounds are closely monitored to ensure that that they are healing correctly and any potential for scarring is caught early.
Additionally, limiting sun exposure on the injured area can also be beneficial, as UV radiation can darken and discolour scar tissue, making it more visible and prominent. The use of protective clothing can help mitigate this risk, or sunscreen if the area is healed.
The use of compression therapy, such as pressure garments or silicone-based scar sheets, can also help minimise the appearance of scars by flattening and softening the scar tissue over time.
Coping with the emotional and psychological effects of scars
It is important to acknowledge the emotional toll that scarring can take and to provide appropriate support and resources for those who are struggling with the psychological effects. One of the first steps in coping with the emotional impact of scars is to recognise that these skin conditions are a common and natural part of the body's healing process. Scars do not define an individual's worth or attractiveness.
Seeking support from friends, family, or mental health professionals can be invaluable in navigating the emotional journey associated with scarring. Counselling or therapy can provide a safe space for individuals to explore their feelings, develop coping strategies, and cultivate self-acceptance.
Additionally, connecting with support groups can help individuals feel less alone in their experiences and provide a sense of community and understanding. Sharing stories, exchanging tips, and learning from others who have faced similar challenges can be a powerful tool in the healing process.
By supporting one another and fostering a culture of self-love and acceptance, we can empower individuals to embrace their scars with pride and confidence, enhancing their overall well-being and quality of life.