Everything You Need to Know About Scarring and Scar Treatments

Scars are a natural consequence of the body’s healing process, yet they can sometimes lead to frustration or self-consciousness. They develop as the skin repairs itself following damage from acne, injury, surgery, or other causes. Not all scars are alike; understanding the different types and available treatment options is essential for effective management. This article explores the reasons behind scar formation, the types of scars, and evidence-based treatments that can help improve their appearance.

What Causes Scarring?

 When the skin sustains damage, the body produces collagen, a protein essential for repairing and strengthening the affected area. This natural healing process leads to the formation of scar tissue, which frequently exhibits a different texture and appearance compared to the surrounding skin. Several factors influence the characteristics of scarring, including the depth and size of the wound, its location on the body, genetic predispositions, and individual skin type (1). 

Types of Scars

Scars come in various forms, each with unique characteristics and treatment options. Here are some of the most common types (2):

 Atrophic Scars

These scars appear as depressions or indentations in the skin, often occurring after conditions like acne or chickenpox. Atrophic scars are usually caused by a lack of collagen during the healing process, leading to a sunken or uneven appearance.

 Hypertrophic Scars

Unlike atrophic scars, hypertrophic scars are raised above the skin’s surface. They form due to an overproduction of collagen, appearing typically as thick, red, or pink scars that may diminish over time. Hypertrophic scars are common after surgeries or injuries.

 Keloid Scars

Keloids are a more severe form of hypertrophic scars that extend beyond the original wound. They are often thick, raised, and darker than the surrounding skin. Depending on their location, keloids may cause discomfort, itching, and restricted movement.

Contracture Scars

These scars occur after significant skin damage, such as burns. They tighten the skin and sometimes affect muscles and nerves. Contracture scars located near joints or other sensitive areas can restrict movement.  

Stretch Marks

Although not always classified as scars, stretch marks are caused by rapid skin stretching or shrinking due to weight fluctuations, pregnancy, or growth spurts. The rapid change disrupts the skin’s collagen and elastin structure, resulting in lines or streaks on the skin.

Treatments for Scars 

Treating scars frequently requires a multi-faceted approach, as no single treatment works universally for all scar types. Here are some common treatments, from over-the-counter options to professional procedures with scientific backing: 

Topical Treatments

1. Silicone Gel or Sheets: Studies have shown that silicone gel and sheets can reduce scar thickness, color, and texture over time by hydrating the scar tissue and helping to balance collagen production (3).
2. Over-the-counter Creams: Products containing ingredients like retinoids, vitamin C, or hyaluronic acid can help improve the appearance of scars. While they may not remove scars, they can soften and lighten them (4).
3. Onion Extract Gel: Onion extract is believed to have anti-inflammatory properties, which may help reduce scar redness, although more studies are needed to confirm its effectiveness. Onion extract gels are commonly found in some scar creams.

 Injections

1. Corticosteroid Injections: These are often used on hypertrophic and keloid scars to reduce inflammation and flatten the raised tissue. This treatment is most effective when performed over multiple sessions (5).
2. Collagen or Filler Injections: For atrophic scars, especially those caused by acne, collagen or other fillers can be injected to “fill in” the depression temporarily. The effect lasts a few months, after which repeat treatments are usually required.

Laser Therapy

1. Ablative Lasers: These lasers remove the top layer of skin, helping to resurface and smooth the scar. Ablative laser treatments work well for acne and surgical scars, but recovery can take several weeks (6).
2. Non-Ablative Lasers: Stimulate collagen production without removing skin layers, making them suitable for milder scars with less downtime.

 

Microneedling

Microneedling involves tiny needles that create micro-injuries on the skin’s surface, which can encourage collagen production and help reduce scar depth over time. Studies show it’s effective for atrophic scars, especially acne scars, though multiple sessions are often required for optimal results (5).

Surgical Options

1. Scar Revision Surgery: This is an option for severe wounds, especially keloid and contracture scars. This process involves removing the scar tissue and re-closing the wound to minimize scarring. Sometimes, a plastic surgeon may graft skin from another area to improve movement and appearance.
2. Punch Excision for Acne Scars: This technique removes individual atrophic scars, typically with a small tool that “punches out” the scar and then reattaches the edges of the skin.

Cryotherapy

Cryotherapy (freezing the scar tissue with liquid nitrogen) can be effective for raised scars, especially keloids. For more significant results, it’s typically combined with corticosteroid injections. 

Managing Scars at Home: Tips for Prevention and Improvement

While professional treatments can be effective, taking proactive steps at home may improve scar healing and appearance. Here are some helpful tips:

Keep Wounds Clean and Moisturized

Keeping wounds clean and using an ointment for hydration can help reduce scarring by preventing infection and promoting better healing.

Avoid Sun Exposure

UV rays can darken scar tissue, making it more noticeable. Applying sunscreen or covering the scar is essential, especially for new scars.

Massage the Scar

Massaging scar tissues gently helps soften them and improve blood flow, potentially reducing thickness and stiffness in raised scars.

Stay Consistent with Treatment

Scars take time to heal and respond to treatment, so consistency is essential. Whether applying silicone gel daily or attending multiple laser sessions, having patience can lead to better outcomes.

Conclusion

Scars are a natural component of the body’s healing process. Although they may never fully fade away, numerous treatments can significantly enhance their appearance. Options range from over-the-counter creams and silicone sheets to professional therapies such as laser treatments and injections. The most effective treatment often depends on the type of scar and individual skin characteristics, making it essential to consult a dermatologist to develop a tailored approach that addresses specific needs. With patience and the right treatment, you can feel more at ease with your skin and scars.

By: Zoha Mortazavi (Pharm. D)

Edited by: Damilola Elewa