Scars, like acne, are extremely common. Like acne, it’s also a source of concern and anxiety for many people. This article addresses what scars are, why we get them, and how we can best prevent them from forming, as well as ways that we can treat them after they have formed.
Scars are a Feature
Scars mean different things across different eras and cultures. Scars can signify membership to a group, a rite of passage, a point of pride, shame, or relationships between people or groups, depending on the context.1 Throughout history, we’ve known about scars and the process in which they form; many tribes have elaborate methods to create scars – almost like artwork.
Culture can add meaning to scars, but fundamentally, scarring is a biological process. Scarring is specifically designed to protect us. It has a function and design. Scars are part of an emergency system that quickly seals up a wound, replaces the damaged skin with a new one (albeit imperfectly). Scar tissue is not only cosmetically imperfect but also has functional impairments as well:
- Sweat glands and hair follicles do not grow back
- Scar tissue is also more susceptible to UV light
- Scar tissue is less resilient to heat, pressure, moisture, lack of nutrition from blood vessels2
Why would the body produce inferior skin? Speed. Scars form quickly and prevent us from being exposed to various antigens (bacteria, virus, fungi) for too long.3 Given that scarring isn’t a disease or condition but a function, we should know to expect to scar when the body is injured. There’s not much that we can do about scars forming – and indeed, if we didn’t form scars, things would be a lot more problematic. However, there are many ways to mitigate the prominence of the scar or minimize its chance of forming.
Types of Scars
Although the underlying process is the same, there are a few scar types that warrant different treatment methods.
Hypertrophic scars: The most common scar type – the scar is raised above the level of the surrounding skin. Hypertrophic scars take the form of a red raised lump on the skin. They usually occur within 4 to 8 weeks following wound infection or wound closure.
Keloid scars: Keloid scars are a type of abnormal scar tissue growth. Like hypertrophic scars, they are raised above the skin level but continue far more than normal scars. Keloid scars are more common in dark-skinned individuals. They are usually pink or red.
Atrophic Scars: Atrophic scars have a sunken appearance – and form “potholes” where the affected skin is lower than the surrounding skin. These are frequently caused by acne.
Acne scars: These are not a type of scar, per se. However, since acne is an essential cause of scarring, we’ve added them here. Discoloration from acne scars is distinct from those caused by pimples. To treat acne scars, it’s important to address the underlying acne first. Without treating the acne, there will always be a risk of new scars forming.
The first question that’s frequently asked is, do scars ever go away naturally? After all, most of us have scars of some kind, major or minor. Similarly, most of us would prefer not to try out any unnecessary interventions. Scars are permanent in theory. In practice, however, most scars slowly fade and become less prominent over time. The bad news is that this process can take a very long time (years, if not decades).
In terms of treatment, what are the options?
Surgery: Scars are removed either surgically or via laser or dermabrasion. Generally, surgery is reserved for cases where the scars impair movement. Treating scars can be challenging, as the surgery can trigger new scar formation.
Injections: Steroids are injected into keloid scars to reduce their bulk. Fillers can sometimes be used to “fill in” atrophic scars that are common in acne patients.
Other: Sometimes topical medication like steroids or antihistamines can control itching and other related symptoms.
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3Scarring isn’t the only process in nature. Some organisms like salamanders regenerate completely without any deterioration – even limbs. Unfortunately, humans aren’t that cool. There is, however, a branch of medicine that studies human regeneration, and this may turn out to be critical in the future.