Why do scars form?
Under ideal circumstances, a break in the skin would stimulate the skin’s own repair processes to seal up the wound and restore normal skin. Clotting factors in the blood would stop the bleeding by forming a scab. The second deepest layer of the skin (the dermis) would produce new cells called fibroblasts. Those fibroblasts would produce collagen and other proteins to seal up the wound and produce a seamless layer of new skin. In some cases, evidence of the wound skin completely disappears in about a week, leaving no scar at all.
For the skin to heal without leaving a scar, healing processes have to occur at exactly the right time in precisely the right degree. However, the body puts a premium on fast healing rather than accurate healing.1 Prehistoric man had a better chance at survival if a wound healed quickly than if it had healed perfectly. The skin had to close quickly to prevent excessive blood loss and infection. When the skin heals quickly, the skin that covers the wound is structurally different from normal skin. The wound heals, but the scar tissue that remains is usually permanent.
Steps to minimize scars during the healing process
The first few weeks after surgery or an injury is a critical time for skin healing. The steps one takes during this time can influence whether a scar forms, or how bad that scar looks in the future.
The skin experts at the American Academy of Dermatology recommend six steps to reduce the appearance of scars after an injury.
- Keep the wound clean – clean the wound with mild soap and water
- Keep the wound moist – petroleum jelly can help keep the wound moist
- Keep the wound covered with an adhesive bandage – This keeps the skin clean and moist
- Change the bandage daily to keep the wound clean – The wound should be gently cleaned once a day, then kept moist with new petroleum jelly and bandages
- Follow your doctor’s advice about stitches – This only applies in some skin injuries, obviously
- Protect the wound from the sun’s ultraviolet (UV) radiation – UV radiation can damage skin, but scar tissue is substantially more sensitive to the harmful effects of UV radiation. Sun protection reduces the risk of cancer in a healing wound and keeps the scar from becoming red or dark.
Types of scars
In the skin’s effort to heal quickly, it may form scars of various types. While the above information applies to all wounds, there are some specific tips and tricks to reduce the appearance of each type of scar.
Fine line scar
A fine line scar is the best-case scenario of scar formation. Fine line scars usually occur when the wound is straight, has clean edges, and free from infection. Precise surgical incisions usually result in fine line scars where the scar is slightly lighter or darker than the surrounding skin.
The best way to minimize fine line scars is to make sure there is no excessive tension on the wound as it heals. Make sure bandages are taped securely to the skin directly underneath, not pulling on the edges of the wound. In addition, UV protection is critically important for fine line scars. Direct sunlight makes the color of the scar more noticeable. Chemical peels and laser resurfacing can also help minimize discoloration.
Widespread scars (Stretch marks)
Widespread scars sometimes called stretch marks are usually flat, pale, and look as if the skin has been stretched apart at the scar. Fine line scars can turn into widespread scars about three weeks after surgery.2 Stretch marks can also occur when there is no obvious injury to the skin at all. For example rapid weight gain, pregnancy, and hormonal imbalances can lead to stretch marks.
A fine line scar turns into a widespread scar if there is tension on the wound, so the same rules apply here. On the other hand, applying moderate pressure directly down on the wound can improve healing and minimize the appearance of widespread scars.3
Atrophic scars
Scars that cause a depression, divot, or channel in the skin are called atrophic scars. Common causes of atrophic scars are cystic acne and chickenpox. The scar has fewer collagen fibers than the surrounding skin making it look thinner or indented.
The best way to prevent atrophic scars is to not “pick” at any cyst or boil. Try to let the wound heal naturally without “popping” the blister. A dermatologist can inject the blister with an agent that will reduce it without breaking it open. This should minimize the risk of scarring.
Once an atrophic scar forms, however, it is difficult to change its appearance without medical or cosmetic intervention. Fortunately, chemical peels, laser resurfacing, dermabrasion, and injectable dermal fillers can greatly reduce the look of atrophic scars.4
Contractures
Contractures usually occur when wounds span a joint. Skin needs to be a little more lax or loose when bending around the joint. Unfortunately, scar tissue forms to simply close the wound. Thus as the person uses the joint, the skin will appear stretched and poorly healed.
Wounds that span across a joint should be managed by a medical professional—typically a plastic surgeon. A contracture wound can impair movement at a joint and may require skin grafts.
Hypertrophic scars
Hypertrophic scars are the opposite of atrophic scars. Instead of leaving an indentation, hypertrophic scars have a raised appearance relative to the surrounding skin. Hypertrophic scars are generally formed along the edge of the wound. These scars are often red, itchy, and may become inflamed.
Moisture retention is the key to reducing the size and discomfort associated with hypertrophic scars. Moisture can also make the scar less noticeable. Water evaporates quickly through scar tissue—for even up to a year after the injury5—so it is a good idea to keep the wound moist and covered.6 Taping and moderate compression may also be helpful.
Keloids
Keloids are at particular form of hypertrophic scar. Keloid scar tissue is raised, as it is in hypertrophic scars; however, keloid scar tissue extends beyond the initial wound. It may affect healthy skin surrounding the wound. Like other hypertrophic scars, keloids may be red, inflamed and itchy or painful.
The management of keloids is mostly the same as other hypertrophic scars (moisture, taping, UV protection, moderate compression). Since keloids appear lumped up over wounds, it may seem reasonable to just cut them off. This is hardly ever the correct decision since more keloids tend to form where the skin was cut. Thus, keloids are treated by pressure therapy, steroid injections, prescription creams, and freezing (i.e. internal cryotherapy).3,7
Hy-Tape is important for healthy wound healing
Hy-Tape is an excellent tape to help minimize the appearance of scars during the healing process. Hy-Tape holds strong to keep the healing wound protected, but it is also gentle enough to come off without harming the skin or disrupting the wound. These features are especially important when making frequent bandage changes.
Hy-Tape is waterproof, so it can keep healing wounds clean and moist without rolling or coming off. In fact, Hy-Tape holds better when it is near or slightly above body temperature. When Hy-Tape has warmed to body temperature, it conforms to the body’s unique shape. When properly applied to limb wounds, Hy-Tape can help provide moderate wound compression without damaging fragile tissue.
Lastly, Hy-Tape is rated SPF 50+, which means it will block out UV potentially harmful radiation. Once skin has formed over the scar, Hy-Tape can be placed directly on the scar to provide continuous UV protection.
If you have a surgical wound, or have a scar that requires care to keep it from darkening or not healing properly, call us 1-800-248-0101 so we can evaluate which Hy-Tape product would be best suited for you.
Read our article Scar Protection and the Outdoors for more.
References
1. Bayat A, McGrouther DA, Ferguson MWJ. Skin Scarring. BMJ : British Medical Journal. 2003;326(7380):88-92.
2. Sommerlad BC, Creasey JM. The Stretched Scar: A Clinical and Histological Study. Br J Plast Surg. 1978;31(1):34-45.
3. Monstrey S, Middelkoop E, Vranckx JJ, et al. Updated Scar Management Practical Guidelines: Non-Invasive and Invasive Measures. J Plast Reconstr Aesthet Surg. 2014;67(8):1017-1025. doi:10.1016/j.bjps.2014.04.011
4. Hirsch RJ, Lewis AB. Treatment of Acne Scarring. Semin Cutan Med Surg. 2001;20(3):190-198. doi:10.1053/sder.2001.27557
5. Suetake T, Sasai S, Zhen YX, Ohi T, Tagami H. Functional Analyses of the Stratum Corneum in Scars. Sequential Studies after Injury and Comparison among Keloids, Hypertrophic Scars, and Atrophic Scars. Arch Dermatol. 1996;132(12):1453-1458.
6. Mustoe TA. Evolution of Silicone Therapy and Mechanism of Action in Scar Management. Aesthetic Plast Surg. 2008;32(1):82-92. doi:10.1007/s00266-007-9030-9
7. Har-Shai Y, Amar M, Sabo E. Intralesional Cryotherapy for Enhancing the Involution of Hypertrophic Scars and Keloids. Plast Reconstr Surg. 2003;111(6):1841-1852. doi:10.1097/01.Prs.0000056868.42679.05