Scarring occurs after almost all breaks in the skin, especially after trauma, injury, or surgery. Chaya T. Merrill and Anne Elixhauser, funded by the Agency of Healthcare Research and Quality, estimated that there are more than 34 million surgical procedures carried out annually in the United States, with many resulting in a scar. Scarring is the end point of normal wound healing, though some human tissues such as the gums and liver can heal without the formation of a scar.
Scar Types
There are a range of scar types not just among individuals, but also within the same person and sometimes even in the same scar. Normal scars are flat, pale, thin lines over the original injury. The most challenging clinically and the scars causing the most problems are pathological scars, which include hypertrophic and keloid scarring.
Hypertrophic scars are red, raised and often painful or itchy. Some hypertrophic scars will improve over time. They are common after a burn, or when there is an injury or surgery to certain parts of the body, such as the chest or upper back. Hypertrophic scars are often associated with contractures, especially after a burn. Keloid scarring can occur after a minor injury such as an insect bite, acne or piercing in susceptible individuals. Keloid scars behave like benign growths as they extend beyond the original injury. They do not resolve spontaneously and can recur after treatment.
Clinical Problem
Normal scars cause little problem unless they are on an area of the body that is visible, such as the face. Keloid and hypertrophic scars cannot only be disfiguring, but they can also cause symptoms such as itching and pain. Scarring, particularly after a burn, results in a contracture, or tightening of the skin. These contractures, if located over a joint, can prevent or reduce mobility.
Causes
Keloid scarring is more common in some racial groups. Though many keloid scars are sporadic, a study published by Alexander Marenos and colleagues in "Archives of Dermatology" showed that some individuals had a family predisposition to the scarring, though no genes have yet been identified. Certain injuries such as a burn, or problems with wound-healing, for example infection, can increase the risk of poor scarring, but it is not yet possible to identify individuals who will develop pathological or poor scarring.
Prevention
Individuals with a family history or personal history of pathological scars should avoid having unnecessary damage done to their skin, such as piercing, tattoos or elective cosmetic surgery. These individuals should also inform their surgeon if they have a history or family history of pathological scarring.
Treatment
There are various treatments available, but none is 100 percent effective for all scars and all individuals. Treatments vary from the use of compression garments, silicone gel, and injections of steroids or other agents into the scar, surgery and natural products such as onion extract. However, David T. Robles and colleagues, in the "Dermatology Online Journal" in 2007, reviewed the treatments available for keloid scarring and determined that a combination of treatments was the most effective, though still not 100 percent effective in all cases. However, a number of new therapies are showing promise in reducing if not preventing scarring.
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