Types of scar
There are some general patterns of scarring that we see: most scarring, no matter what the cause, will fall into one of these patterns.
‘NORMAL’ SCARS (FLAT & PALE)
When the healing process occurs as described above, the end result is a flat, pale, supple scar, also referred to as a mature scar. No matter how well you heal there will always be a permanent mark. Some normal scars may become stretched over time, usually due to their location on the body. A number of factors influence whether a scar will mature normally: please see our scar management section for information on how to encourage formation of this type of scar.
The word hypertrophic means ‘overgrown’, and occur where the normal healing process described above is excessive. The scar becomes excessively thick and red/ purple, and may be itchy. Unlike a keloid, the scar tissue does not overgrow the site of original injury. Left alone, hypertrophic scars will tend to fade & flatten over the course of a couple of years. The site on the body, original cause of the wound, the age of the patient, and the degree of skin pigmentation all affect the likelihood of developing a hypertrophic scar. They occur commonly following burns. Self-administered techniques are useful, but sometimes additional treatments are recommended.
A keloid scar is a red/ purple, raised scar, which overgrows the site of the original wound, and is typically painful or itchy. They can arise from a seemingly innocuous injury such as an insect bite or ear piercing. Keloids may occur in anyone, but are commoner in younger patients, at certain sites in the body (earlobes, shoulders, breastbone), in darker skin types, and when a previous keloid had occurred. Left untreated, keloid scars may resolve over the course of many years (on average, seven years), however many patients are understandably keen to hasten the process. It is important to bear in mind that no treatment for keloid is 100% effective, and typically multiple treatments are necessary to achieve an improvement. Keloid scars are very prone to recurrence, and surgical removal alone is usually not recommended as the keloid will almost certainly recur, often worse than before. Surgery is sometimes combined with other treatments.
ATROPHIC/ INDENTED SCARS
Not all problematic scars are lumpy and red: indented or sunken scars, such as can occur following acne or chickenpox, may also cause concern. These scars are difficult to conceal with make-up as it is the shadow cast by the unevenness in the skin that make them obvious. Some treatments may improve the appearance of these scars, but most patients find they would prefer a greater improvement. It is important that any ongoing acne is treated (thus preventing further scars) before embarking on scar treatment procedures.
Any scar can become oversensitive as it heals: this is because nerve endings in the skin get bundled up in the scar tissue and send abnormal signals to the brain. This hypersensitivity may be associated with cold intolerance, abnormal sensations, and pain from the slightest touch. Hypersensitive scars can have a substantial negative impact on patients’ quality of life. One of the most important treatments is scar massage: although touching the scar is the last thing patients feel like doing, it is essential in the prevention and treatment of this problem. Desensitisation exercises, usually prescribed by a plastic surgeon or occupational therapist, are also useful in the management of this problem.