Scars: An Overview

What are scars?
Scars are a natural part of the body’s healing process. A scar results from the biologic process of wound repair in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring.

In most cases, scar tissue is of inferior functional quality to the tissue it replaces. Scars in the skin are less resistant to ultraviolet radiation. Hair follicles and sweat glands do not grow back in the scar tissue.

What causes scars?
Scars can result from accidents, diseases, skin conditions such as acne, or surgeries.

How do scars form?
Scars form when the dermis (the deep, thick layer of skin) is damaged. The body forms new collagen (a naturally occurring protein in the body) fibers to mend the damage, resulting in a scar. The new scar tissue will have a different texture and quality than the surrounding tissue. Scars form after a wound is completely healed.

What are the different kinds of scars?
Most scars are flat and pale. However, in cases when the body produces too much collagen, scars can be raised (i.e., higher than the surrounding skin). Raised scars are called hypertrophic scars or keloid scars. Both of these kinds of scars are more common in younger and dark-skinned people.

Some scars can have a sunken or pitted appearance. This kind of scarring occurs when underlying structures supporting the skin (i.e., fat or muscle) are lost. Some surgical scars have this appearance, as do some scars from acne.

Scars also can appear as stretched skin. Such scars result when the skin stretches rapidly (i.e., as in growth spurts or during pregnancy). In addition, this type of scar can occur when the skin is under tension (near a joint, for example) during the healing process.

How can scars be treated?
Although scars cannot be completely removed, their appearance can be improved. Methods for improving the appearance of scars include:

• Topical treatments—Topical treatments such as vitamin E, cocoa butter cream, and several commercial skin care products like Mederma are available over-the-counter, all with the claim to help heal scars. While these products may work for some people, the evidence supporting the benefits of these treatments is unclear.
• Surgery—Although it will not remove a scar, surgery can be used to alter a scar’s shape or make it less noticeable. Surgery is not recommended in cases of hypertrophic or keloid scarring because there is a risk of recurring scars, as well as more severe scarring, that results from the treatment.
• Steroid injections—A long-term course of steroid injections into a scar may help flatten the scar. Injections may help to soften the appearance of keloid or hypertrophic scars.
• Radiotherapy—Low-dose, superficial radiotherapy is used to prevent recurrence of severe keloid and hypertrophic scarring. This treatment is used only in extreme cases because of potential long-term side effects.
• Dermabrasion—This treatment involves the removal of the surface of the skin with special equipment. Dermabrasion is useful when the scar is raised above the surrounding skin, but it is less useful for the treatment of sunken scars. Microdermabrasion is a much less invasive form of dermabrasion and may be useful for very superficial scars.
• Laser resurfacing—This procedure, similar to dermabrasion, removes the surface layers of the skin using different types of lasers. Newer types of lasers may achieve more subtle results by working on the collagen in the dermis without removing the upper layers of skin. This results in little to no down time, as opposed to traditional laser resurfacing and dermabrasion.
• Collagen and fat injections—These treatments can be used to raise sunken scars to the level of surrounding skin. The effects of these injections are usually only temporary, however, and the procedures may need to be regularly repeated. Newer forms of injectable fillers are now on the market and may be an option in certain cases.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/7/2005