Makindo Medical Notes

Related Subjects: |Anatomy of Skin |Skin and soft tissue and bone infections | Skin or subcutaneous lump |Skin Pathology and Description and Examination |Scars

Scarring is a normal part of the healing process following injury, surgery, burns, or inflammatory skin disease (e.g., acne). It represents the body’s attempt to restore skin integrity through collagen deposition and tissue remodelling. While most scars are harmless, some can cause cosmetic distress, functional impairment, or psychological impact.

🩹 Types of Scars

• ✅ Normotrophic Scars:
  • Flat, pale, or faintly pink scars following uncomplicated wound healing.
  • Blend in with surrounding skin and usually fade with time.
• ⬆️ Hypertrophic Scars:
  • Raised, red, and firm due to excess collagen production.
  • Confined to the wound boundary and may regress over months–years.
  • Common after burns, surgical incisions, and wounds under high skin tension.
• 🟥 Keloid Scars:
  • Thick, overgrown scars that extend beyond wound margins.
  • May cause itching, pain, or cosmetic concerns.
  • High recurrence rate after excision; more common in darker skin (Fitzpatrick IV–VI).
  • Typical sites: chest, shoulders, earlobes, upper back.
• ⬇️ Atrophic Scars:
  • Sunken, pitted scars caused by tissue loss (e.g., acne, chickenpox).
  • Result from destruction of collagen, fat, or underlying dermis.
• 🔥 Contracture Scars:
  • Scar tissue tightens, restricting movement.
  • Often occur after deep burns or large traumatic wounds.
  • May impair joint mobility or function (e.g., over elbows, knees, hands).

⚖️ Factors Influencing Scar Formation

• Wound Depth & Type: Deeper or contaminated wounds → more fibrosis.
• Location: High-tension areas (sternum, shoulders, joints) more prone to hypertrophy/keloids.
• Age: Younger patients form more exuberant scars; older patients heal slower but with less collagen deposition.
• Genetics: Strong family tendency to keloids, esp. in darker skin types.
• Infection/Delayed Healing: Prolonged inflammation worsens scar quality.
• Systemic Factors: Diabetes, immunosuppression, and poor nutrition impair wound healing.

💊 Treatment Options for Scars

• 🧴 Topical Agents: Silicone gels/sheets (first-line for hypertrophic scars); topical corticosteroids or onion extract for mild improvement.
• 💉 Injections: Intralesional corticosteroids reduce collagen synthesis → useful in keloids/hypertrophic scars.
• 🔦 Laser Therapy: Fractional CO₂ or pulsed-dye lasers improve texture, pigmentation, and thickness.
• ❄️ Cryotherapy: Freezing keloids can shrink lesions, often combined with steroid injections.
• ✂️ Surgical Revision: Excision or scar revision with careful closure; high recurrence risk in keloids unless combined with adjuvant therapy.
• 🧦 Pressure Therapy: Pressure garments (e.g., after burns) flatten scars by reducing collagen proliferation.
• 🧪 Other Modalities: Radiotherapy (rare, for resistant keloids), microneedling, dermal fillers (for atrophic scars).

🚨 Complications of Scarring

• Functional Impairment: Contracture scars may limit joint movement or cause deformity.
• Cosmetic/Psychological Impact: Disfiguring scars can lead to anxiety, depression, and reduced quality of life.
• Recurrent Keloids: Difficult to manage; high recurrence even with treatment.
• Chronic Pain/Pruritus: Hypertrophic and keloid scars may remain painful or itchy.

💡 Clinical Pearls: - Hypertrophic vs Keloid: Hypertrophic = within wound margin, tends to regress; Keloid = grows beyond wound, rarely regresses. - Silicone gel sheets are first-line and evidence-based for hypertrophic scar prevention. - Always consider psychological impact of scarring — referral to support services may be appropriate.