Types of Scarring

Scarring occurs when the skin undergoes a repair process after injury. When the skin is damaged beyond the superficial layer, the body forms fibrous tissue, called scar tissue, to heal the wound. Scars can vary in appearance and severity depending on the type of injury, its location, and how well it heals. Different types of scarring have distinct characteristics and may require varied treatments. While some scars fade over time, others can persist or even worsen without proper care.

Signs & Symptoms

The appearance of scars can range widely depending on the type, severity, and location of the injury, as well as individual healing factors. The key signs and symptoms of scarring may include:

Red or pink raised areas: Common with early scars that are still healing.
Flat or depressed skin: Some scars may create indentations or look sunken.
Discolouration: Scars often appear darker (hyperpigmentation) or lighter (hypopigmentation) than the surrounding skin.
Itching or pain: These sensations can be present during the healing process or in certain types of raised scars.
Tightness or restricted movement: Some scars can cause contractures, which tighten the skin and limit mobility, especially around joints.

Depending on the type of scarring, additional symptoms may include hardening or thickening of the scar tissue, and in some cases, ongoing sensitivity at the site.

Causes and Contributing Factors

Scarring is a natural part of the healing process, but certain factors can influence the type and severity of the scar. Common causes and contributing factors include:

Injuries or trauma: Cuts, burns, and abrasions that penetrate the deeper layers of skin are likely to leave scars.
Surgery: Surgical incisions, even when carefully stitched, often result in scarring.
Burns: Deep burns can cause extensive scarring, sometimes resulting in hypertrophic scars or contractures.
Genetics: Some people are more prone to forming raised scars, such as keloids, based on their genetic background.
Infection: Wounds that become infected during the healing process are more likely to scar.
Healing environment: Moist wound care and protection from further injury can promote better healing and reduce scarring. Exposure to sunlight during healing can worsen scarring.

There are several distinct types of scars, each with different characteristics and implications for treatment.

1) Hypertrophic Scars

Hypertrophic scars are raised, red scars that remain within the boundaries of the original wound. They are caused by excessive collagen production during healing. Over time, these scars may flatten and become less noticeable, but they can still cause itching or discomfort. Hypertrophic scars are more common after burns, deep cuts, or surgical wounds.

Key features:

Raised but confined to the original wound site.
May improve naturally over time.
Can be itchy or sensitive.

2) Keloid Scars

Keloid scars are a more severe form of raised scarring, where the scar tissue extends beyond the original injury. They occur when the body continues to produce collagen even after the wound has healed, leading to a larger, thicker scar. Keloids are more common in people with darker skin tones and can continue to grow for months or even years.

Key features:

Raised and spreads beyond the original wound.
Often larger than the initial injury.
May be painful, itchy, or cause discomfort.
Unlikely to improve without intervention.

3) Atrophic Scars

Atrophic scars are characterised by a loss of tissue, leading to a sunken or pitted appearance. These scars commonly result from conditions like acne or chickenpox, where inflammation destroys skin tissue. Atrophic scars can also occur after certain surgical procedures or from traumatic injuries.

Key features:

Sunken or depressed areas of skin.
Can appear smooth but lower than the surrounding skin.
Common after acne or chickenpox.

4) Contracture Scars

Contracture scars occur when a large area of skin is damaged, often from burns. As the skin heals, it tightens, which can impair movement, especially if the scar crosses a joint. These scars can affect muscles and nerves beneath the skin, further limiting mobility.

Key features:

Tightened skin, reducing range of motion.
Often thick and inflexible.
Can involve deeper tissues, muscles, or nerves.

5) Stretch Marks (Striae)

Stretch marks are a form of scarring that results from the rapid stretching of the skin, such as during pregnancy, weight gain, or growth spurts. These scars appear as long, narrow streaks that are initially red or purple but may fade to white or silver over time.

Key features:

Thin lines or streaks on the skin.
Typically found on the abdomen, thighs, breasts, or buttocks.
Can improve with time but often remain visible.

Prognosis

The outlook for scars depends on several factors, including the type of scar, its location, and how well the wound was cared for. In many cases, scars will fade or improve over time, though they may not completely disappear. Early and appropriate treatment can minimise scar formation and improve long-term outcomes.

Hypertrophic scars often flatten within 6 to 18 months.
Keloid scars tend to persist and may even enlarge without intervention.
Atrophic scars generally remain but can be improved with specific treatments.
Contracture scars can restrict movement and may require surgery or physiotherapy to improve mobility.

Treatment

Treating scars effectively depends on the type of scar and its severity. Treatment options range from conservative approaches like creams and silicone gels to more invasive procedures such as laser therapy or surgery. Physiotherapy plays an essential role in managing certain types of scarring, particularly those that affect movement or function.

Medical and Non-invasive Treatments

Topical treatments: Creams containing ingredients like silicone, vitamin E, or corticosteroids may help flatten and soften scars. Silicone sheets or gels are particularly effective for hypertrophic and keloid scars.
Pressure therapy: Specialised garments that apply pressure to healing wounds can prevent hypertrophic scarring, especially after burns.
Steroid injections: Injecting corticosteroids into hypertrophic or keloid scars can reduce inflammation and flatten the scar over time.
Laser therapy: Lasers can help reduce the redness of scars and improve their texture. They are commonly used for hypertrophic, atrophic, and stretch marks.
Microneedling: This procedure uses tiny needles to stimulate collagen production, improving the appearance of atrophic scars.

Physiotherapy and Rehabilitation

For scars that limit movement, such as contracture scars, physiotherapy is essential to restore function and mobility. Techniques used by physiotherapists include:

Stretching and range-of-motion exercises: These exercises help maintain flexibility and prevent further tightening of the scar tissue.
Massage: Scar tissue massage can soften thickened areas and improve circulation to the healing skin.
Splinting: In severe cases, physiotherapists may use splints to support proper joint positioning and reduce the risk of contractures.

Surgical and Invasive Treatments

Scar revision surgery: Surgeons can remove large or problematic scars and close the wound with better alignment to minimise the scar’s appearance.
Skin grafts: In cases of extensive damage, such as with large burns, skin grafts may be necessary to replace lost tissue and improve healing.
Radiotherapy: Occasionally used for keloids to prevent recurrence after surgery.

Information is provided for education purposes only. Always consult your physiotherapist or other health professional.