Scars form as part of the healing process after skin damage. Most people will get a scar of some kind during their lifetime. It can be the result of an accident, surgery or a poorly healing skin condition.
The scar is part of the healing process of damaged skin.
Once the skin is broken, the wound heals and closes.
The skin heals itself by the process of new tissue growth. It contracts and fills the gap caused by the injury. It fills with repair cells. It is referred to as granulation tissue.
Scar tissue is made up of proteins and collagen.
A fresh wound is red because of the presence of capillaries (very thin veins, called hair cells). After the capillaries fade, the scar becomes paler. Normally, only thin, pale lines are visible after the scar has healed.
The skin and its structure
The skin is the largest organ of the human body. It comes into contact with both the external and internal environment of the body.
The skin consists of three main layers. These are the epidermis, dermis and subcutis. These layers are composed of other layers.
The epidermis - The top layer of the epidermis is what we touch and see. It protects the body from external influences. The epidermis is made up of five other layers. They are made up of keratin and epidermal lipids.
Dermis - The dermis is the middle layer of the skin. It is firm and elastic. It consists of two layers. Its building blocks are elastin and collagen.
Hypodermis - The hypodermis is the lowest layer of the skin. It consists of fat cells, collagen fibres and blood vessels.
Wound healing
When an injury occurs, bleeding occurs. The blood begins to clot and forms an insoluble membrane to close the scab.
The body begins to use protective mechanisms to destroy bacteria and dead cells.
The damaged and dead cells then dissolve and decompose.
New cells begin to form. It's called epithelialization.
The course of wound healing and scar formation. Photo source: Getty Images
Scar formation
A scar is formed by damage to the suture. The skin heals at the damaged site by the formation of monoform collagen fibres. A less elastic scar is formed.
The new tissue has a different structure and quality than the surrounding tissue. Therefore, scars form after healing.
Symptoms of scarring
On lighter skin, the scar is initially red or pink. It fades over time. Gradually, it changes colour to lighter or darker than the skin colour.
On darker skin colours, scars look more like dark spots.
The scars may
hurt
itch
be sensitive to touch or completely numb
turn red
swollen, inflamed
limit range of motion
cause a scratching sensation
The scar heals in about 3 to 6 months. Sometimes it can take up to two years.
Scar formation is an irreversible process and cannot be completely removed.
It most often forms after an injury or surgery.
Can a scar still hurt years later?
When a scar forms, a person feels pain. It improves as the wound heals. It may disappear completely or return years later as a pain in the wound.
A scar can cause pain due to:
skin tension
nerve damage
growth of excessive scar tissue
Painful scars are more likely to form after damage to the skin and soft tissues during surgery or trauma.
A burn scar in a larger affected area may be itchy or painful in addition to reducing range of motion. It can significantly reduce quality of life.
The type of pain may be:
Chronic nerve pain
throbbing
shooting
dull pain
When deeper layers of tissue are affected during surgery, a scar forms not only on the surface but also along the entire wound. It can scar the healthy tissue in the surrounding area, e.g. joints after knee surgery or after surgery in the abdominal cavity (removal of the appendix or caesarean section in women).
Scarring of the inner parts of the tissue can affect healthy tissue and cause adhesions. Adhesions can attach to other healthy tissue. They can cause pain when moving or changing position.
They often occur after surgery in the abdomen, pelvis and chest.
This pain can be addressed with corrective surgery or surgical removal of adhesions.
Scar healing is influenced by
the use of the finest possible sutures after surgery
infection at the wound site - an inflamed wound heals more slowly and less easily
skin quality
the depth of the wound
the body's ability to regenerate
intake of protein, minerals and vitamins in the diet
hydration of the body
the psychological state of the person
What negatively affects wound healing and impairs the quality of healing?
Allergic reaction to the material used in suturing, to drugs, ointments, disinfection in wound care
infection at the wound site or general infection in the body
a wound in the joint flexion, where it is re-stressed and broken
inadequate cleaning of the wound after trauma with the presence of foreign bodies
insufficient blood supply to the tissue
administration of immunosuppressive drugs during anti-inflammatory treatment
type of injury - physical (surgery, piercing), pathological (acne)
inadequate nutrition
obesity, which is a common reason for wound breakdown (adipose tissue restricts blood supply and prevents wound edges from adhering)
The scar is part of the natural healing process of the skin.
Types of scars
The healing of a scar is influenced by a number of different factors. According to them, it leaves its typical signs.
Atrophic scar
Atrophic scars are linear, initially reddish scars. They gradually change colour to silvery white.
They are caused by the formation of insufficient new tissue.
They occur after injuries, after spontaneous healing of bedsores, after injection of corticosteroids or after surgery and wound healing. This type of wound most often occurs on the abdomen, back, buttocks, shoulders and thighs.
Atrophic scars also include stretch marks. They are tiny scars, cracks on the surface of the skin. They are caused by cracking of the skin at puberty, during pregnancy, in some diseases, with rapid weight gain, after taking anabolics.
Atrophic scars are also common after chicken pox and acne. They appear as rounded dimples or small depressions in the skin. They form after scratching a blister or rash. The skin cannot heal and a ligamentous scar is formed.
A hypertrophic scar does not extend beyond the wound. It is usually raised above the level of the skin.
It can appear as early as 4 weeks after the injury. It often resolves spontaneously within 12-18 months.
It is usually caused by excessive collagenous tissue of the skin. This type of scar is more common in blacks and Asians.
The hypertrophic scar is thick, hard and red in colour. It can be painful and uncomfortable, sometimes itchy.
It also forms after deep burns. Deeper and longer healing burns are more likely to have hypertrophic scars. They form gradually, especially in the first few months after the burn.
The development of a hypertrophic scar after healing occurs in the first to sixth month. Initially, the scar is red, pink or purplish, raised above the skin surface.
It is without elasticity, fragile and rigid, unyielding. It itches, is dry and sometimes painful. It often shrinks and forms irregular scar-like stripes.
One to three years after the burn, the scar fades. It flattens, softens and becomes more pliable. During this period, it is sometimes necessary to undergo corrective surgery on the scar.
Keloid scar
Keloids are benign skin lesions of irregular shape.
Keloids grow into the surrounding healthy tissue.
They are rounded and thick. They form clusters of scar tissue. They spread into healthy tissue.
They protrude over the edge of the wound. They tend to be red or darker in colour than the surrounding tissue. They itch, can be painful and are the least elastic.
They may appear 3 months to a year after the wound has formed.
Hyperplastic scar
Hyperplastic scars are hypertrophic scars with keloid.
They arise from an excessive amount of collagenous tissue in the scar. The main cause of formation is not precisely known.
They can form after infection, burns and after piercing. They grow into bizarre shapes.
These wounds itch. People experience muscle discomfort and pain. Aesthetically, they look unsightly.
In addition to aesthetic objection, keloid and hypertrophic scars can cause limitation of function, such as restriction of joint mobility.
Acne scars
Acne scars are caused when the inflammation of the rash penetrates deeper into the skin. The inflammation also damages the tissue under the skin.
During the healing process, collagen is produced. When there is more or less collagen production, a scar is formed.
Acne scars can be:
Atrophic- There is little collagen production and depressions form in the skin.
Hypertrophic - Hypertrophic scars are caused by excessive collagen production. Small bulges with dark colouring protrude above the skin.
Aburn is an injury to the skin caused by contact with high heat, electricity, gas or chemicals. It leaves physical and psychological scars.
It is one of the most serious injuries. It requires long, very complicated and expensive treatment.
Burns usually leave serious consequences.
In some cases, burns lead to tissue death. They are divided into grades I to III according to the depth of tissue involvement.
The following table shows the grades of burns with a description
I. stier
Is a superficial burn with only interstitial swelling manifested by redness.
Such damage to the skin does not leave a scar. The increased pigmentation at the burn site disappears with time.
II. stage
Superficial tissue necrosis occurs.
If there is no infection, the scar heals within 2 weeks. In most cases, it heals without permanent consequences.
The scar tends to be less noticeable. Different pigmentation of the scar may persist.
A fresh wound has a dark red or marbled pale colour with less pain.
Healing in case of tissue necrosis sometimes requires surgical treatment. Replacement with a skin graft, called dermoepidermal autotransplantation, may be necessary.
III. Grade
Grade III is severe. There is complete damage to the skin and part of the subcutaneous adipose tissue.
The fresh scar is waxy white, pearly, yellow, but also dark brown to black in colour.
The scar is painless and numb.
Small wounds heal with a skin graft. Larger scars require surgical treatment. The dead tissue removed is replaced with a skin graft.
The healing time depends on the time of epithelial re-formation.
Read also.
Contractures
Contractures occur when a large part of the skin is damaged and lost. The resulting scar sometimes makes movement difficult, especially in areas above the joint. It often occurs after burns.
Wound and scar care
Keep the scar clean.
Do not scratch the scab and wait for it to detach spontaneously.
Do not scratch the wound .
Do not expose the scar to sunlight for 3 months after it has formed. This may cause hyperpigmentation.
Do not visit saunas, solariums or cold environments.
Limit stretching of the skin during sports activities for at least 6 weeks.
After removing the stitches, perform pressure massage on the healed wound. It should be performed at least 3 times a day for 10 minutes for 1-2 weeks. Pressure massage of the scar is performed by repeatedly squeezing the scar and pushing. When pushing, the scar should disappear. Then release the pressure. In 1-2 months, the effect of the massage will become apparent.
Do not wear tight clothing made of synthetic material. By rubbing the scar, the sensitive tissue reacts by hardening and reddening.
For the first 2-4 weeks, do not take a bath. Only showering is recommended. During showering, wash the wound only with clean water. Do not use perfumed soaps or products with alcohol, menthol, eucalyptus, citrus. They may irritate the wound. Dry the wound only by applying a towel.
Massage the scar regularly to prevent it from drying out.
Treatments to reduce and remove the scar
The key to treatment is to start caring for the wound as soon as possible. This will increase the chances of successful healing.
Wound healing is a long process.
The damaged tissue and the resulting scar need regular care in the form of softening, moistening and massage.
The sooner you start caring for the scar, the sooner it will heal.
Scar treatment options
For fresh keloids and hypertrophic scars, pressure massage and pressure compression bandages have a good effect. However, their application must be long-term.
You can also use an occlusive dressing with petroleum jelly, glycerin gel, heparin, plant extracts, corticosteroids.
For some surgical interventions, silicone is used preventively in the form of gel, silicone sheets or cream for fresh wounds.
Silicone sheets have been developed for the treatment of hypertrophic and keloid scars, in skin injuries, after burns.
Steroid hormones in the form of cream, ointment, in occlusive dressings are used for collagen synthesis. They reduce inflammation.
Homeopathic preparations for scars
Graphite is swallowed in the form of granules. This remedy has a wide range of uses. One of them is the prevention of keloid formation.
Arnica montana CH9 is a preparation is in the form of granules. It has anti-inflammatory, regenerative effects on blood vessels. It helps to absorb hematomas.
Staphysagria CH5 helps heal surgical incision wounds, e.g. after caesarean section, perineal incision.
Pyrogenium CH9 is given in granular form to prevent suppurative complications in infected wounds.
Cytovital is applied in the form of a cream. It has anti-inflammatory, antiseptic, regenerative effects. It facilitates the healing process of scars.
Natural remedies are cheaper and with timely initiation of treatment have good effects on wound healing.
A decoction or tea of St. John's wort is recommended for wound rubbing. After it has healed, you can use St. John's wort oil to rub the wound daily.
Fenugreek is used to make a strong decoction. Soak a cotton swab in it and apply to the wound.
Castor oil helps to heal scars. It softens already formed scars, which fade and smooth out.
Coconut oil helps heal scars.
Aloe vera helps regenerate tissue in scars, acne, stretch marks and burns.
Rosehip seed oil helps wound healing, softens stretch marks. Removes fine scars from acne, pox.
Healing agents containing silicone
Silicone relieves pain, reduces the formation of protruding scars, improves range of motion.
Cica-care for the treatment of keloid and hypertrophic scars
ASO patch for purple hypertrophic and keloid scars
Mepiform silicone for keloids and hypertrophic scars
Topigel, Silipos, Dermatix SiGel, Pro-Sil are self-drying gels. They heal scarred skin surface after surgical procedures, laser treatments, burns, traumatic injuries.
Healing agents without silicone content
Contractubex gel promotes the formation of epithelization, has an anti-inflammatory effect.
Hemagel retains moisture in the wound, accelerates the healing process. It is suitable for chronic and acute wounds (diabetic foot, bedsores, postoperative skin damage, bedsores).
Flamigel promotes the formation of new tissue, heals the wound and skin. It is suitable for burns and wounds.
Heparoid has regenerative effects. It softens stiff scars.
ISIS Glyco A cream flattens scars, especially after acne.
Syn Care Keloderm prevents wound stretching. It softens scars. It is suitable for keloid scars.
Avéne Cicalfate cream reparatrice promotes tissue regeneration. It has anti-inflammatory effects. It is suitable after burns, for fresh scars.
Bepanthen is a product to accelerate wound healing. It is applied to the skin. It covers the wound and protects it from infection. It maintains a suitable environment for wound healing. Another advantage is the reduction of the risk of scarring.
Treatment of scars
When scar healing is poor and conservative treatment is insufficient, consultation with a skin doctor or plastic surgeon is recommended.
Based on the consultation and the type of scar, the best method will be offered . It may include dermabrasion, chemical peels, collagen injections and other methods in order to smooth the skin surface.
Scar Correction- The optimal time for scar correction is one year after the scar has appeared.
Scar correction is aimed at improving the appearance of the scar, removing the scar, or camouflaging the scar. Different techniques can be used to do this, depending on the type and size of the scar.
Options include laser correction, scar excision, liquid nitrogen crystallization, radiotherapy or transplantation of the patient's own skin cells or cells from a donor.
In most cases, the procedures have to be repeated. They are quite expensive.
Treatment according to the type of scar
Hypotrophic scars (sunken scars) are usually cut out and then sutured in plastic surgery. The suturing must be precise. Sometimes the use of filler techniques is an option.
Hypertrophic scars are treated by dermabrasion or excision. They are then precisely sutured with the possible application of corticosteroids.
Corticosteroid solutions in the scar, cryotherapy, laser (radiotherapy, pressure therapy) are used to treat hypertrophic and keloid scars.
Hypertrophic scars tend to heal spontaneously. Keloid scars tend to recur.
Surgical treatment is not recommended for keloid scars. It is most commonly treated by injecting corticosteroids into the scar. Corticosteroids gradually soften the scar and cause it to fade.
In atrophic scars and stretch marks, the aim is to promote collagen formation in the scar. Fractional CO2 laser resuscitation, needle radiotherapy, plasma therapy are used.
For hyperplastic and atrophic scars, injection enzymotherapy is appropriate. In case of failure, excision is performed.
The treatment option for atrophic acne scars is filling them with hyaluronic acid.
Treatment of scars using special techniques
Various techniques for treating scars are used in the skin doctor's office and in aesthetic medicine clinics.
Dermabrasion is used for superficial scars, to minimise acne scars, small scars, surgical scars and for minor irregularities in the skin surface.
In dermabrasion, the device is used to gently abrade the top layer of skin. After abrading, the skin surface appears lighter and smoother due to healing.
Microdermabrasion is a gentler treatment than dermabrasion. It has a similar effect to chemical peels. It is suitable for small acne scars.
Microneedles can be used. By applying small needles, targeted damage is done to the skin. The damage starts the process of collagen production to smooth the scar.
Chemical peels are mainly used for superficial scars and irregularities in skin pigment colour.
It is performed using glycolic or salicylic acid. It removes the outer layer of the skin. It is suitable for all acne scars and deeper atrophic scars.
Laser resurfacing is used to minimize wrinkles, to soften hypertrophic scars. It is suitable for all types of acne scars.
Using thin laser beams, the skin is heated. After the treatment, the top part of the skin is removed. The skin underneath exerts heat on the cells responsible for acne pigment spots.
Targeted damaged skin heals faster with the help of healthy, intact skin.
Thermal fillers are another option. In the case of sunken acne pits, the sunken part of the skin is filled in. This lifts the pit.
With collagen injections, one type of collagen is injected under the skin. It replaces the body's natural collagen. It is used to smooth out wrinkles and scars.
Another option is steroid injection. A steroid drug is injected into the raised scar, which results in flattening it.
Cortisone injections help soften and reduce a hard scar, such as in keloids or hypertrophic scars.
In cryosurgery, liquid nitrogen is used to freeze the raised scar. It freezes the top layer of skin and reduces the size of the scar.
Excision is the surgical removal of the scar and subsequent suturing.
The biolamp has a very good healing effect on various diseases as well as wound and scar treatment.
It is used in medical and cosmetic facilities. Thanks to the penetration of light rays, it helps in removing scars after acne, after injuries or after surgery.
Tattooing scars. Some people have their scars artistically covered with tattoos. We recommend that you see and consult a dermatologist before deciding to cover a wound with a tattoo.
Not every scar is suitable for such artistic covering. In some cases, it is not recommended at all, for example, with keloid scars.
Home treatment of acne scars
At home to treat and relieve the appearance of unsightly acne scars, you can try preparations:
Lactic acid helps with acne and increased pigmentation.
Retinoids accelerate cell regeneration and reduce the visibility of scars. They are suitable for atrophic scars.
Salicylic acid promotes scar healing.
AHAs with lactic and glycolic acids help to remove unevenness and visibility of the scar.
BHA has a good effect in the treatment of acne scars. It is suitable for all types of scars. When choosing, also look for the salicylic acid content in the products.
Azelaic acid is helpful for all types of acne scars and for increased pigmentation (Skinoren).
Vitamin C has very good anti-inflammatory properties. It helps with hyperpigmentation. It brightens the skin, revitalises it and promotes collagen production. It is suitable for acne scars and blemishes.
Red ice light therapy reduces inflammation. It accelerates cell renewal, which helps with acne scars.
Whitening creams for brown acne spots are used to correct acne spots and scars, especially on the face.
Zinc ointments have anti-inflammatory and soothing effects on acne. They can reduce the appearance of scars.
Bi-oil for scars reduces bulging hypertrophic scars.
Contractubex gel is suitable for hypertrophic scars.
Homemade natural recipes and creams for acne scars
Lemon juice is one of the folk remedies for fading brown spots after acne. It needs a longer application time.
Aloe vera extract helps in healing without causing scars.
Virgin coconut oil is anti-inflammatory, antibacterial, soothing and moisturizing. It accelerates the healing of acne wounds and reduces the risk of scarring.
Honey promotes wound healing and reduces the risk of scarring.
Black seed oil is anti-inflammatory, accelerates and improves wound healing and evens out skin pigmentation.
Rosehip seed oil reduces surgical scars and acne scars.
Exercises to relax the wound
You can use calendula cream to massage the scar.
Massage the wound with gentle pressure. Run your thumb over the skin in a semi-circular (C-shaped) pattern to create an eyelash. The wound may be hard and unyielding at first. With regular massage, it will gradually relax. Massage it in this way from both sides.
Another option is to gently grasp the wound between your fingers in the shape of an eyelash and massage in opposite directions with your fingers in the shape of the letter S. This slowly loosens the skin.
I graduated from the Secondary Medical School in Nitra, which gave me the basis for a career in healthcare. After school I worked for three years in the surgical department and then in the department of Anaesthesia and Intensive Care Medicine. In addition to my employment, I completed my bachelor's degree at the Faculty of Health Care in Banská Bystrica in Nursing and completed my specialisation studies in Anaesthesiology and Intensive Care Medicine. Since my childhood I was determined to become a health professional and help people with their health problems. Continuous education and study of new professional topics related to health care, which is constantly evolving, and gaining practical experience, helps me to write professional articles for this portal, which is available to everyone. My hobbies are multifaceted, I am also involved in healthy nutrition, overall healthy lifestyle. I spend my free time on education, creative work, handicrafts in cooperation with my daughter, thanks to which, we do not know boredom.
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