How are scars formed?
When the skin is injured, there is a break in the body’s tissues.
The body produces more of a protein called collagen, as part of the healing process. Collagen builds up where the tissue has been damaged, helping to heal and strengthen the wound.
For a period of about three months or longer, new collagen continues to form and blood supply increases, causing the scar to become raised, lumpy and red. Some collagen then breaks down at the site of the wound, the blood supply reduces and the scar may gradually become smoother, softer and paler. 4
The healing process can be from 12 to 18 months. Some scars heal naturally. Other scars require additional treatment. 5
Symptoms of scars
Some individuals may suffer from skin irritations, tingling or prickling of the skin or pain due to their scar. 6
Visual characteristics of a scar may include: 3
- Appearing flat
- Lumpy/ raised
- Sunken / depressed
- Varying in colour (vs. the normal skin tone)
The appearance of a scar is influenced by many factors including: 3
- Skin type
- Location on the body
- Direction of the wound
- Type of injury
- Age of the person
- Nutritional status of the individual
Types of scars4
The most common type of scar is a flat, pale scar that forms as a result of the body’s natural healing process. Initially, they may be red or dark and raised after the wound has healed, but will become paler and flatter naturally over time as the injury heals.
Hypertrophic scars may be the result of an imbalance in the production of collagen when a wound is healing. They do not extend beyond the boundary of the original wound, but may continue to thicken for up to six months.
A hypertrophic scar is a red, raised scar that forms along a wound and can have the following characteristics for around two to five years:
- it can restrict movement because scar tissue is not as flexible as the original skin
- it heals within the size of the original wound
- the healing tissue is thicker than usual
- it is red and raised initially, becoming flatter and paler with time
Hypertrophic scars can have this appearance for many years.
A keloid scar is an overgrowth of tissue that occurs when too much collagen is produced at the site of the wound and the scar keeps growing, even after the wound has healed.
Keloid scars often have the following characteristics:
- they are often raised above the skin
- they can feel itchy
- they can feel painful
- they can appear much larger than the original wound
- they can cause a burning sensation and feel tender to touch
- they can restrict movement if they are tight and near a joint
- they are raised above the skin
- they are hairless and appear shiny
- they feel hard and have a “rubbery” texture, although some keloid scars can form soft lumps (such as on the ear lobe after piercings)
- a newly-formed keloid scar is red or purple, becoming paler with time
Scar contractures are commonly caused by burns. These occur when the skin “shrinks”, leading to tightness and a restriction in movement.