CLINICAL
CLINICAL
OPHTHALMOLOGY
CPD
DERMATOLOGY
A BRIEF OVERVIEW OF
COMMON SCARS
Dr Rakesh Newaj
Specialist Dermatologist
Arwyp Medical Centre and
Glynwood Hospital
It is always more beneficial to prevent and decrease scar formation than trying to manage it.
A scar is a mark or abnormal tissue
texture left on the skin or within
body tissue where a wound, burn
or sore has not healed completely
and fibrous connective tissue has
developed. Beneath the skin is the
subcutaneous tissue, composed of cells
called fibroblasts, which after injury
are stimulated to grow into granulation
tissue, knitting the wound together.
Scar tissue is formed by dense masses
of granulation tissue. Acne scars,
keloids and hypertrophic scars are the
most types of scars seen on the skin of
human beings.
Acne formation has been attributed
to multiple factors such as increased
sebum production, alteration of the
quality of sebum lipids, proliferation
of P. acnes as well as follicular
hyperkeranisation. Once the acne has
formed, any injury to the skin, initiates
a cascade of wound healing events
which results in inflammation followed
by granulation, tissue formation and
matrix remodelling. Scars result
from an aberrant response to wound
healing at various stages. These
are broadly categorised as either a
result of increased or lack of tissue
formation (hypertrophic and atrophic
respectively).
Atrophic scars include the ice pick
scars, rolling or box car scarring. Ice
pick scars are narrow in diameter
(<2mm), deep, sharply marginated
epithelial tracts that extend vertically
to the deep dermis or subcutaneous
tissue. The opening is usually wider
than the deeper infundibulum as the
scar tapers from the surface to its
deepest apex, hence forming a V shape.
Rolling scars are poorly demarcated
depressions of the skin with vertical
extension limited to the depth
corresponding to epidermal thickness.
They occur from dermal tethering of
otherwise relatively
Table 1: Management of scars
normal appearing skin
and are usually wider
than 4-5mm. Abnormal
fibers anchoring of the
dermis and subcutis
leads to superficial
shadowing and a rolling
undulating appearance
to the overlying skin. Box
car scars are uniform,
round or oval scars
with well-established
vertical edges that reach
a depth corresponding
to the superficial or deep
dermis and are usually
wider at the surface.
Scars formed
by increased tissue
formation are divided into
hypertrophic and keloid
prone to develop keloids. Certain areas
scars and can occur due
to acne or several other types of injuries of the body such as the sternum, deltoid
region of the upper arm and the upper
to the skin. Hypertrophic scars are
back have increased susceptibility to
widened or unsightly scars that do not
keloids. As for the head and neck region,
extend beyond the boundaries of the
wound. They tend to reach a certain size it is more common on the earlobes,
mandibular border and the posterior
and subsequently stabilise or regress
neck. The central region of the face
within a few months to years. The scars
tends to be spared in most cases.
look pink, raised and firm with thick
hyalinised collagen bundles within the
MODIFYING SCARS
borders of the original site of injury.
It is always more beneficial to prevent
These scars do not have a racial or
and decrease scar formation than
familial preponderance.
Keloid scars are caused by abnormal trying to manage them. The avoidance
of picking, scrubbing or any harsh
growth of tissue beyond the boundaries
procedures on acne lesions as well as
of the original site of skin injury. The
early, aggressive medical treatment
lesions can be nodular or smooth,
can go a long way in preventing scar
mostly asymmetrical and growth is
formation. As for patients who are
unpredictable. Some can also be itchy
prone to keloid formation, the use
and painful. Adverse wound healing
precautionary measures during surgery
processes, such as infection, excessive
and repair will go a long way. Once
tension, foreign bodies and repetitive
formed the scars need to be managed
trauma can be contributory factors as
according to severity, skin colour,
well. Darker skin patients and those
affordability as well as expectations of
with a family history, are also more
the patients who must also be realistic.
Scars cannot be erased, however, they
can be modified to make them more
pleasing. The common methods used
to manage different scars, is listed in
Table 1.
CONCLUSION
Scars are an indelible reminder of
possible dreaded outcome of injury,
operation, burns or sometimes even
diseases like acne, chicken pox, lupus,
pyoderma gangrenosum.
They can adversely affect the
social functioning of the person,
leading to severe psychologic
depression. Therefore, the medical
practitioner has to be compassionate
and refer selected patients for
psycological help. Some of the
treatments can also have adverse
outcomes and patients should be
made aware of them and the proper
consent forms should be signed before
initiating any treatment.
MEDICAL CHRONICLE | OCTOBER 2016 45