Scars

What are scars?

Scars form as part of the healing process after your skin has been cut or damaged. The skin repairs itself by growing new tissue to pull together the wound and fill in any gaps caused by the injury. Scar tissue is made primarily of a protein called collagen.

Scars develop in all shapes and sizes. Some scars are large and painful, while some are barely visible. People with dark skin (especially people with African, Asian or Hispanic heritage), as well as red-haired individuals, are more likely to develop keloid scars. Keloids are raised scars that grow and extend beyond the injured area. Depending on their size, type and location, your scars may look unsightly and may even make it difficult to move.

Not all scars require treatment, and many fade away over time. If a scar is bothering you or causing pain, treatments can help.

How common are scars?

Nearly everyone develops some type of scar, whether from an accident, a surgical procedure, acne or an illness like chickenpox (varicella). Scars affect people of all ages and genders.

What are the signs of a scar?

When a scar first develops on lighter skin, it’s usually pink or red. Over time, the pinkish color fades, and the scar becomes slightly darker or lighter than the color of the skin. In people with dark skin, scars often appear as dark spots. Sometimes scars itch, and they may be painful or tender.

A scar’s appearance depends on several factors, including:

• Injury or event that caused the scar, such as surgery, a burn or severe acne.
• Size, severity and location of the wound.
• Treatment you received for the wound, such as stitches or bandages.
• Your age, genes, ethnicity and overall health.

What are the types of scars?

Scars can develop anywhere on the skin. There are several types of scars, including:

• Contracture: Often developing after a burn, a contracture scar causes the skin to tighten (contract). These scars can make it difficult to move, especially when the scarring gets into the muscles and nerves or occurs over a joint.
• Depressed (atrophic): These sunken scars often result from chickenpox or acne. They look like rounded pits or small indentations in the skin. Also called ice pick scars, they develop most often on the face. Acne scars may become more noticeable as you age because the skin loses collagen and elasticity over time.
• Flat: Although it may be slightly raised at first, this type of scar flattens out as it heals. Flat scars are often pink or red. Over time, they may become slightly lighter or darker than the surrounding skin.
• Keloids: These scars are raised above the skin’s surface and spread beyond the wounded area. The overgrown scar tissue can get large and may affect movement.
• Raised (hypertrophic): You can feel a hypertrophic scar when you run your finger over it. These raised scars may get smaller over time, but they never completely flatten out. Unlike keloids, they don’t grow or spread beyond the wounded area.
• Stretch marks: When skin expands or shrinks quickly, the connective tissues under the skin can be damaged. Stretch marks often develop during pregnancy, puberty or after gaining or losing a lot of weight. They usually appear on the breasts, stomach, thighs and upper arms.

Scar tissue can also build up inside the body. Internal scar tissue can result from surgery (like abdominal adhesions) and some health conditions, such as Asherman’s syndrome and Peyronie’s disease. An autoimmune disease such as scleroderma creates skin changes resembling scarring from the inflammation in the skin.

What causes scars?

Scars are part of the body’s healing process. As part of your immune system, your skin is the barrier to protect you from germs and other harmful substances. When skin is injured, the body creates new tissue made of collagen to help reseal itself.

Collagen plays many important roles throughout your body, including plumping up your skin and helping your cartilage protect your joints. When a scar develops, collagen fibers repair damaged skin and close any open areas. The new tissue protects you from infection.

How are scars diagnosed?

You can easily diagnose most scars yourself by keeping an eye on an area of skin that has healed from an injury. Scars often look darker, lighter or pinker than the surrounding skin.

Your healthcare provider will do a physical examination to evaluate a scar that’s causing problems. Your provider will look at the scar’s size, texture and color to determine its type. Treatments vary depending on the type of scar, its location, what caused it and how long you’ve had it.

Can scars be treated?

Several treatments can make scars smaller or less noticeable. Your healthcare provider may recommend one treatment or a combination. Scar treatment depends on several factors, including:

• Type, size and location of the scar.
• Whether the scar is causing you pain or affecting your ability to move.
• Your age and the age of the scar.

What are the treatments for scars?

Treatments can reduce a scar’s size or appearance, but the scar will never completely go away. Some treatments prevent a scar from forming as a wound heals. Scar treatments include:

• Dermabrasion: A common acne scar treatment, dermabrasion removes the top layer of skin by gently “sanding” the skin. The procedure softens and smooths the skin and can improve the appearance of scars.
• Injections: Your healthcare provider injects medication directly into the scar, making it smaller and flatter. Corticosteroid injections can reduce the size of keloid scars. Your healthcare provider may inject drugs that treat cancer, such as bleomycin (Bleo 15k™) and fluorouracil (Adrucil® or 5-FU), to flatten scars and reduce itching and pain.
• Laser treatments: Several types of laser and light treatments can make scars (including acne scars) less noticeable. Laser treatments use a particular wavelength of light to cause a particular action in the skin. The V beam is a pulsed dye laser at 595 nm (nanometers) that targets small blood vessels in the skin. Sometimes the scars remain pink or red because the new blood vessels that developed to heal the wound never receded once their job was done. This laser can cauterize the small vessels from the inside out to remove them from the scar and allow the pink or red color to fade. This action may also help the scar flatten if it’s too thick or thicken if it is too thin. Other lasers (such as the Fraxel laser) can vaporize small columns of tissue within the scar to break up the collagen fibers and allow the scar to remodel and become more flexible. The treatments can also help with pain, itching and sensitivity. Laser treatments may cause hyperpigmentation (skin darkening) or hypopigmentation (skin lightening) in people who have dark skin. Talk to your healthcare provider about side effects before starting treatments.
• Pressure therapy: An elastic bandage, dressing or stocking puts pressure on a wound during the healing process. The pressure prevents a scar from forming or decreases its size. Massage therapy can also help break up scar tissue and allow it to remodel.
• Scar-revision surgery: A range of surgical procedures can remove a scar, improve its appearance or transplant skin from another area (skin graft). This is an exchange of one type of scar for a different, more preferable scar.
• Topical creams and ointments: Applying silicone ointment to a scar may make it smaller or prevent it from forming. Or your healthcare provider may recommend applying corticosteroid cream or a silicone gel sheet to the area. If you have dark skin, ask your provider about using a skin-lightening cream with hydroquinone to lighten scars.

Can I prevent scars?

Although you can’t always prevent injuries that cause scars, you can reduce the risk of a scar forming after an injury. If a scar does develop, careful care can make the scar less noticeable.

To reduce the risk of scarring, you should:

• See your healthcare provider: If you have a wound that may leave a scar, visit your provider for an examination. You may need stitches or special bandages to hold the skin together while it heals. Stitches can minimize scarring. Be sure to follow your provider’s instructions when caring for stitches. Depending on the type and location of the wound you may need oral or topical antibiotics to prevent infection.
• Clean the wound: Wash the area with soap and water. Clean out any dirt or dried blood, and apply a bandage over the wound to keep germs out. Be sure to change the bandage often as the wound heals.
• Keep the wound moist: Applying petroleum jelly or moist burn pads will keep the wound from becoming too dry and developing a scab. Scabs can make scarring worse.
• Protect it from the sun: Cover the scar or use sunscreen to protect it. Sun exposure can make a scar darker. Repeated exposure increases the risk of developing skin cancer.
• Keep up your nutrition: Having low levels of vitamin D or C in your system can make scarring worse and you need adequate high quality protein in your diet to help your skin make what is needed to heal.

Do scars fade, shrink or become less noticeable over time?

Most scars fade over time and don’t cause long-term health problems. How a scar changes depends on its location, size and type. A scar may fade so much that you can barely see it, but it never completely goes away.

Some scars cause problems months or years later. As nerve endings grow back, the scar may become painful or itchy. Skin cancer can develop in scars, especially in burn scars. To avoid skin cancer, wear sunscreen or keep your scar covered.

When should I see my healthcare provider about a scar?

If a scar’s appearance bothers you, talk to your provider about procedures that can make it less noticeable. Also see your provider if the scar changes or is painful, tender, itchy or infected. And if you notice a mole, freckle or growth on or near the scar, call your provider right away. This may be a sign of skin cancer, which can grow in a scar.

If you’ve had a keloid scar, you’re more likely to develop another one. Talk to your provider before getting piercings, tattoos or elective surgery (such as cosmetic surgery). Your provider will recommend precautions (like wearing a pressure garment) if skin starts to thicken and turn into a keloid.

A note from Cleveland Clinic

See your healthcare provider if you’re unhappy with how a scar looks. You may not have to live with a scar that bothers you. Several effective treatments can make scars flatter or less noticeable. After treatment, you may not even notice the scar at all. If a scar is causing discomfort or making it difficult for you to move, call your healthcare provider. Treatments can improve movement and relieve pain. Always protect scars from the sun to reduce your risk of skin cancer.