In popular culture, scars are often portrayed with a sense of romance, where the scars on your body are made out to be a reflection of the experiences you have had. This to me is at best an incomplete idea and at worst just plain silly. The reality is that scars more often than not, draw unnecessary negative attention to a person and most of my patients treat them as an unwanted feature.
What exactly is a scar and how is it formed?
When you injure your skin, the body reacts to it by initiating an inflammation response to the injury which first contains the injury and then starts the tissue repair process. During the tissue repair phase there is a proliferation of cells from the adjoining areas to the injured area and the wound is closed with the formation of collagen and elastin fibres. (Collagen is a protein which is one of the basic building blocks of all tissue, skin bones, etc.)
However as the skin and tissue heal, often the healed area becomes uneven and has a different texture and quality because of the nature of the injury. And hence we get what is called as scar tissue.
What are the factors on which the appearance of scars depends on?
When a scar first develops on lighter skin, it’s usually pink or red. Over time, the pinkish colour fades, and the scar becomes slightly darker or lighter than the colour of the skin. In people with dark skin, scars often appear as dark spots.
The appearance of a scar depends on several factors such as:
– 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?
There are several types of scars, including:
1. Depressed (atrophic) Scars:
These sunken scars occur due to chickenpox or acne. They look like rounded pits or small indentations in the skin. Ice pick scars and box scars develop due to cystic acne. Acne scars may become more noticeable as you age because the skin loses collagen and elasticity over time and the depressions look more pronounced.
2. Contracture Scars:
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.
3. Flat Scars:
These scars start off as slightly raised scars but flatten out eventually. Flat scars are often pink or red initially and later turn darker.
4. Keloidal Scars:
Some people have a tendency to developing keloidal scars. These scars are raised above the skin’s surface and spread beyond the wounded area. These are slightly itchy. The overgrown scar tissue can get large and may affect movement. Commonly seen on the chest or any surgical scars or deep injury.
5. Raised (hypertrophic) Scars:
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.
So what are stretch marks and are they different from scars?
Stretch marks differ from scars in the fact that they are not caused because of injuries. They are generally caused when skin expands or shrinks quickly. In this case, the connective tissues under the skin can be damaged and also there are changes in the collagen and elastin fibres. Stretch marks generally present themselves like lines or striae, where the skin seems to have been ‘stretched’.
In their early stages of formation, stretch marks are reddish in appearance and as they mature and settle down, they tend to become whitish in appearance.
Stretch marks commonly develop during pregnancy, puberty or after gaining or losing a lot of weight. They can also be caused during certain conditions like cushings syndrome etc. They usually appear on the stomach, thighs, upper arms or back.
How to treat scars and stretch marks?
Both scars and stretch marks are primarily the resultant of an inconsistent cell structure (collagen and elastin fibre formations) in the skin and hence both have similar lines of treatment which aim at restructuring the skin cells.
It is important to note that the best way to treat scars and stretch marks is to treat early, that is during their phase of formation.
Topical Creams and Ointments:
These generally have limited efficacy in terms of restructuring the scars and are useful during the formation stage of scars and stretch marks.
Micro-Needling / Skin Resurfacing:
This is the process in which a micro needling device like a derma roller or derma pen is used to create controlled injury on the area to be treated. The idea is that the treatment should stimulate collagen formation and neo-vascularization. This leads to formation of skin structure which is very similar to the structure of the skin in the vicinity.
Fractionated Laser Treatment:
This is a process in which the area to be treated is exposed to a fractionated (split) laser beam. This causes microscopic injuries in the area to be treated. This again leads to improved collagen and elastin synthesis and hence a skin structure that is smoother and more even.
PRP (Platelet Rich Plasma) Treatment:
PRP is a solution derived from the patient’s own blood which is extremely rich in growth factor proteins. Such a serum is dispersed on the area being treated by laser or micro needling and causes an improved response during the healing stage and leads to better results.
For raised and keloidal scars injecting certain medications into the scars can help settle them and improve their aesthetic appearance.
Unfortunately, there are some scars like contractures that cannot be treated by non-invasive and injectable treatments. In this case, the only thing that works is surgery.
The important thing to understand with scars is that they do not need to define you. If you think that scars are causing you undue stress in your life, you should seek out the help of a dermatologist immediately.
The objective of this article is to educate the reader and help them make wiser choices under the guidance of a trained dermatologist. It is not meant to be used by patients for self-diagnosis or for avoiding proper medical treatment. The images used in the above blog are only for visual representation purposes. Actual procedures and results may vary from patient to patient.
About Dr. Sejal Saheta and InUrSkn:
Built on more than a decade of experience of Dr. Sejal Saheta, we are an honest and affordable skin and hair care clinic in Powai, Mumbai. Our goal is to make each patient comfortable and happy with their appearance with the least amount of intervention.
Dr. Sejal Saheta has dual degrees of MD and DNB in dermatology and venereology and has worked alongside some of the senior-most doctors at the largest hospitals in Mumbai.
Located in Powai, InUrSkn is the largest skin and hair clinic in the central suburbs of Mumbai and offers the latest technology in the safety of world-class infrastructure.
We are happy to be a part of your journey to reach your health goals. If you think we have been able to help you, please do review us:
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How can Dr. Sejal and InUrSkn help?
No matter what your skin and hair needs, Dr Sejal Saheta ensures personal attention to each patient and creates customized and scientifically-backed treatment plans for each patient. Through her years of experience and use of technology at her clinic (InUrSkn – Skin and Hair Clinic) located in Powai, Mumbai, she has been able to consistently deliver great results in the field of dermatology and trichology to thousands of patients. All of the above is done with the best-in-class machines within the comfort and safety of world-class infrastructure.