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A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from normal biological process of wound healing. Except for very minor and superficial injuries, every wound gives rise to some degree of scarring.



Superficial wounds such as minor scratching heal by the regeneration of skin cells on the wound surface. There is no defect in the skin continuity, and the skin accessory structures such as sweat glands, hair follicles and sebum glands are intact. This type of healing does not cause scar formation.  


On the other hand, the healings of deeper wounds invariably are associated with scar formation. The extent of the scar formation depends on the severity of the wound and how the wound is managed. Wounds that are promptly managed by cleansing and surgical closure (suturing) are associated with faster healing and less scarring. Wounds that are deep, contaminated, infected or not promptly treated will result in the formation of abundant scar tissue.


Scar formation usually becomes active in the third to six months during wound healing. During this time the scars usually appear red, elevated and tense. However, this active phase will subside subsequently and the scars become thinner and the colour lightens. However, once the scar is formed, it will remain in the skin permanently. A clean cut that is repaired and closed properly produces a fine scar that is hardly noticeable. On the other hand, deep and extensive wounds produce massive scarring with loss of skin function and significant changes in skin appearance.


Excessive scar formation gives rise to hypertrophic scars and keloids. A hypertrophic scar is a widened and elevated scar that is confined within the boundaries of the wound and usually resemble a red lump on the skin. Hypertrophic scar reaches a certain size and subsequently stabilizes or regresses. Keloids are more serious form of excessive scarring and they can grow beyond the boundaries of the original wound into a very large lump. Keloids have the clinical appearance of a raised exuberant growth and are frequently associated with itchiness and pain.


Risk Factors of hypertrophic scars and keloids:

1.    Wound locations. Hypertrophic scars and keloids commonly occur in areas of the body that are subject to repeated stretching and tension, such as the shoulder and chest. On the other hand, hypertrophic scars and keloids rarely occur in the palm, sole or eyelids.

2.    Infection. Wound infections cause excess scarring.

3.    Wound closure. Wounds that are unrepaired and left to heal on its own result in excessive scarring compared to wounds that are closed promptly and properly.

4.    Age. Hypertrophic scarring and keloids are more common in young patients.

5.    Genetic predisposition. Certain individuals and groups are more prone to keloids formation due to genetic makeup. Keloids are seen with greater frequency in blacks and Asian populations.


Prevention of Scars

Early wound closures and prevention of wound infection are important measures that prevent excessive scarring. Other preventive measures include sun protection, maintain skin moisture by using moisturizer and silicone sheet, taping and splinting, massage and physiotherapy. Itchiness is common during the process of wound healing. Patients are advised to avoid scratching which can cause injury to the skin and aggravates scarring.



Treatments of Scars

Once a scar is formed, it will never completely go away. However, there are many treatments available that can help to reduce its size and change its appearance to be become less obvious. The best treatment to use depends on many factors such as the size, location, duration, functional disability, aesthetic concerns and patient preference and compliance.

1.    Silicone sheets and silicone gel (scar gel). Silicone sheets can be used after surgery to improve scarring. They are applied on the scar throughout day and night including during sleep. They can be removed temporarily during shower. A piece of silicone sheet is reusable for several weeks with proper care. Silicone gel can be used as an alternative to silicone sheet.

2.    Pressure garments. Pressure garments made of elastic material have been a mainstay of scar control for burn injuries.

3.    Massage. Massaging scar tissue can help to decrease scarring build-up and reduce the ‘tightness’ of the scar tissue. Apply vitamin E lotion or baby oil to the scar area. Use the thumb or fingers to firmly massage in circular motion for 5 minutes, alternate between clockwise and anticlockwise motions. Repeat 2-3 times a day.

4.    Corticosteroid injections. Corticosteroids such as triamcinolone acetonide can be used to treat hypertrophic scars and keloids as monotherapy or in combination with other therapies. Corticosteroid injections are usually effective in flattening hypertrophic scars and keloids with high response rate. Multiple injections may be required to achieve satisfactory results.

5.    Laser therapies. Lasers are most often used as a non-invasive option to improve scar texture, contour, and hyperpigmentation. Lasers are usually used in combination with other treatments modalities such as occlusion/compression therapy or intralesional corticosteroid injection.

6.    Botulinum toxin A (Botoxâ). Botulinum toxin A can be used to decrease the tissue tensile forces in the scars and reduce scarring.

7.    Surgical subcision: A form of treatment for depressed scar with can be combined with fat grafting.

8.    Scar revision surgery:  scar revision is surgery to improve the appearance of scar and to restore functional disability caused by the scar. Depends on the size and location of the scar, various techniques can be used such as direct scar excision and closure, z-plasty, w-plasty, local flap and tissue expander.


Pantai Hospital Ampang
Jalan Perubatan 1, Pandan Indah, 55100
  Kuala Lumpur, Malaysia

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