Why do scars form on the skin?

Many different things can cause scarring on the skin, but why does the skin form differently at such a site?

Scars result from the biological process of wound repair in the skin and other body tissues.

The formation of a scar is a natural healing process that occurs after you are injured. It is an area of fibrous tissue that replaces normal skin after an injury.

Scar tissues is composed of the same collagen as the tissue it has replaced, but its composition is different; instead of the random basket weave formation of collagen fibres we find in regular skin, scarred skin undergoes a process called fibrosis, in which the collagen cross-links and forms a pronounced alignment in a single direction.

This tissue is usually of inferior quality and is less resistant to UV radiation. Sweat glands and hair follicles do not grow back in this tissue. It is also more susceptible to stretching if it occurs on an area of skin that gets moved or pulled tightly.

This new, inferior quality skin usually remains a different colour to normal skin, and the high melanin levels in darker skin may make scarring more noticeable.

While scars are generally not problematic from a medical perspective, they can trouble individuals for a number of reasons, including :

  • Their redness, making them very noticeable on the skin and possibly quite disfiguring if on the face
  • Keloid scars. These scars, often arising after inoculations, can be treated with intralesional steroids
  • Stiff or harder than normal skin
  • Raised and uneven
  • Stretched
  • Itchy
  • Sunken
  • Contracted
  •  Can cause distortion to surrounding tissues
  • Pigmented or pale, making them obvious.

Treating scars

Treatment of a scar depends on the type of scar, the skin type of the patient and the extent of scaring.

The major scar types and their treatments are :

  • Red scars. These scars may be able to be treated with a vascular laser to lessen their colouring
  • Keloid scars. These scars, often arising after inoculations, can be treated with intralesional steroids
  • Tethered scars. These can be treated with subcision or punch excision
  • Various other scarring can be improved through the use of Fraxel 1550nm or Carbon Dioxide laser, facial resurfacing or fillers.
  • Acne scarring. Many of the treatments above are available for acne scars.