Overview

Scars
Scars

A scar is a mark left on the skin after a wound or injury has healed.

Scars are a natural part of the healing process.  Most will fade and become paler over time, although they never completely disappear.

Types of scars

A scar can be a fine line or a pitted hole on the skin, or an abnormal overgrowth of tissue.

Normal fine-line scars

A minor wound like a cut will usually heal to leabe a red, raised line, which will gradually get paler and flatter over time.

This process can take up to two years.  The scar won't disappear completely and you'll be left with a visible mark or line.

Fine-line scars are common following a wound or after surgery.  They aren't usually painful, but they may be itchy for a few months.

On darker skin types, the scar tissue may fade to leave a brown or white mark.  A pale scar may be more obvious on tanned skin because scar tissue doen't tan.

Keloid scars

A keloid scar is an overgrowth of tissue that occurs when too much collagen is produced at the site of the wound.

The scar keeps growing, even after the wound has healed.

Keloid scars are raised above the skin and are red or purple when newly formed, before gradually becoming paler.  They're often itchy or painful, and can restrict movement if they're tight and near a joint.

Hypertrophic scars

Like keloid scars, hypertrophic scars are the result of excess collagen being produced at the site of a wound.

But not as much collagen is produced in hypertrophic scars compared with keloid scars.

Also, unlike keloid scars, hypertrophic scars don't extend beyond the boundary of the original wound, but they may continue to thicken for up to six months.

Hypertrophic scars are red and raised to start with, before becoming flatter and paler over the course of several years.

Pitted or sunken scars

Some scars caused by skin conditions, such as acne or chickenpox, can have a sunken or pitted appearance.

Pitted scars, also known as atrophic or 'ice-pick' scars, can also occur as a result of an injury that causes a loss of underlying fat.

Scar contractures

Scar contractures are often caused by burns.

They occur when the skin "shrinks", leading to tightness and a restriction in movement.

Treating scars

Complete scar removal isn't possible, but most scars will gradually fade and become paler over time.

A number of treatments are available that may improve a scar's appearance and help make it less visible.

If scarring is unsightly, uncomfortable or restrictive, treatment options may include:

  • topical silicone gel or silicone gel sheets
  • pressure dressings
  • steroids
  • skin camouflage (make-up)
  • surgery

In many cases, a combination of treatments can be used.

Emotional effects of scarring

Scarring can affect you both physically and psychologically.

A scar, particularly if it's on your face, can be very distressing.  The situation can be made worse if you feel you're being stared at.

If you avoid meeting people because of your appearance, it's easy to become socially isolated.  This can lead to feelings of depression.

See your GP if you feel your scars are making you depressed, or if they're affecting your daily activities.

Help and support

A number of support groups and organisations provide help and advice for people living with scarring.

These include:

How scars normally form

Scarring is part of the body's natural healing process after tissue is damaged.

When the skin is wounded, the tissues break, which causes a protein called collagen to be released.  Collagen builds up where the tissue is damaged, helping to heal and strengthen the wound.

New collagen continues forming for several months and the blood supply increases, causing the scar to become red, raised and lumpy.

In time, some collagen breaks down at the site of the wound and the blood supply reduces.  The scar gradually becomes smoother, softer and paler.

Although scars are permanent, they can fade over a period of up to two years.  It's unlikely they'll fade any more after this time.

Stretch marks

Stretch marks are narrow streaks or lines that appear on the skin's surface when the deeper layer of skin (dermis) tears.

They're often caused by hormonal changes that occur during pregnancy or puberty, or as a result of bodybuilding or hormone replacement therapy.

^^ Back to top

Treatment

A number of treatments are available if you hae a scar that's painful, itchy or unsightly, or if it restricts your movement.

Scars can't be removed completely, but they can often be made less visible.

Your GP may refer you to a dermatologist (skin specialist) or a plastic surgeon for treatment.  Some treatments, such as laser therapy, aren't widely available on the NHS, so you'll need to pay for them privately.

Skin camouflage (make-up)

You can buy make-up that's specially designed for covering scars from pharmacies.  It can be particularly useful for facial scars.

The skin camouflage service isn't available in Wales and Northern Ireland. Find out about the further support services available in these countries.

Silicone gels or sheets

Silicone gels or sheets can be used on healing skin (not open wounds) to help soften and flatten a scar.  They can also relieve itching and discomfort.

To be effective, silicone gels or sheets should be placed over the scar for 12 hours a day for at least three months.  They can be washed and reused.

Ask your GP, dermatologist or pharmacist if they can recommend a suitable silicone-based scar treatment for you.

Steroids

Steroids can't remove scars completely, but they can improve their appearance.

Corticosteroid injections can be used to treat some keloid and hypertrophic scars.

The scar is injected a number of times to reduce any swelling and flatten it. Depending on the type of scar, the injections may need to be repeated.

Injections are usually given on three occasions, four to six weeks apart, to assess your body's response. Treatment may continue for several months if the scar is improving.

Steroid-impregnated tape can also be used to try to flatten keloid scars. It can be prescribed by a GP or dermatologist and is applied for 12 hours a day. 

Laser therapy

Laser or light therapy (pulses of light) can reduce the redness in a scar by targeting the blood vessels in the excess scar tissue.

For some pitted scars, laser surgery (laser resurfacing) is used to try to make the scar flatter. This involves using a laser to remove the top layers of skin, which stimulates collagen production in the deeper layers.

But there aren't many long-term studies to prove the effectiveness and safety of laser therapy. If you have laser therapy, make sure the person doing it is a fully trained medical practitioner with experience in improving scars.

Cryotherapy

Liquid nitrogen can be used to freeze keloid scars. If cryotherapy is used in the early stages, it may flatten keloid scars and stop them growing. A side effect of treatment is that it can lighten the colour of the skin in the area being treated.

Dermal fillers

Dermal fillers are injections (often of a man-made acid) used to "plump up" pitted scars. Treatments can be costly and the results are usually temporary. Repeat treatments are needed to maintain the effect.

Skin needling

Skin needling, which involves rolling a small device covered in hundreds of tiny needles across the skin, can also help improve the appearance of scars. But repeat treatments are often needed to achieve an effect, and results vary considerably.

Surgery

urgery can sometimes be used to improve a scar by:

  • making it appear more natural 
  • making it less noticeable (by using a skin graft) 
  • releasing a tight scar that's close to a joint to improve movement

Scar reduction surgery is an invasive treatment that may not be suitable for everyone.

You should carefully consider the pros and cons before deciding to have surgery. As well as the normal risks of surgery, there's also a chance of making the scar worse.

If you're considering scar reduction surgery, make sure the plastic surgeon is fully trained and experienced in this type of surgery. You should fully discuss the procedure with your surgeon so you're aware of the risks and expected results.

If surgery is used to treat a keloid scar, you may also need other treatments immediately after surgery, such as steroid injections or radiotherapy, to stop the scar growing back larger.

Pressure dressings

Pressure dressings are usually used under specialist supervision for treating large burn scars or after skin grafts. The aim is to flatten and soften the scars.

Pressure dressings are usually made from a stretchy, elastic material. They're worn over the scar 24 hours a day for around 6 to 12 months. They can also be used with silicone gel sheeting to improve the appearance of scars over a long period of time.

Scars and skin creams

Vitamin E cream is sometimes recommended for managing scars, but there's no medical evidence to suggest it has an effect.

But massaging a moisturiser like E45 into the scar will stop it becoming dry and help make it supple.

You should also apply sunscreen to your scar as it may be particularly sensitive to the sun.

^^ Back to top


The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 27/10/2020 14:01:42