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How to prevent scarring

Side profile of woman with acne scars on her cheek thinking of types of scars
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A scar is a mark left on the skin after a wound has healed. Most people gain a scar or two as they go through life. But, the appearance of the scar can vary depending on the type and severity of the initial injury or wound. This can sometimes lead to discomfort, and affect confidence – especially if the scar is in a visible area.

Scars are a normal part of the healing process and will often fade and settle over time, but they do not completely disappear. In this article we look at some of the different types of scars that can occur, and how best to treat them.

How do scars form?

When skin is broken – be it by injury, surgery, illness or other causes – the upper layers of the epidermis (skin) are damaged. If this is surface damage only, a more minor cut or lesion may not leave a scar. If the deeper, underlying layers of skin (dermis) are broken, then the body produces extra collagen to repair the skin, and this newly-formed skin can have a different appearance and texture to the original, older skin.

Types of scars

More minor types of wound leave behind a ‘fine line’ scar. This is a line of scar tissue that may appear raised or reddened as the skin knits together, but should flatten over time, and the skin may return to a close to normal colour. Often the scar is slightly paler or darker than the surrounding skin.

Atrophic scars

Atrophic scars have a pitted or sunken appearance. They are sometimes referred to as ‘ice pick’ scars, and appear sunken as the result of a lack of underlying fat in the affected areas. These most usually occur as a result of skin conditions such as acne, or chicken pox.

Atrophic scar on face illustration

Hypertrophic scars

Hypertrophic scars form at the site of the original wound. They are caused by an excess of collagen in the area of the wound as the skin binds together during the healing process. They are raised, can appear red and are often itchy. This localised thickening of the skin should stop after around 6 months, and after that the scar should start to settle.

Over time, the scar should flatten, redness should disappear, and the scar will be less noticeable. The most common examples of hypertrophic scars are found after caesarean sections (c-section) births.

Illustration of hypertrophic scar on arm

Keloid scars

Keloid scars form in the same way as hypertrophic scars – by the body directing collagen to the wound site during the healing process. With keloid scars, however, the scarring is not constrained to the original wound site, resulting in larger-looking raised and thickened scarring that does not settle down. Normally these scars are painless. However, in rare cases this can cause discomfort and reduced mobility – especially if the scar is near a joint. This type of scar may feel itchy, painful or tight, but not always. Keloid scars can develop as a result of a wide range of wounds – from smaller piercings to surgery. 

The development of a keloid scar is unpredictable, and is not dependent on the severity or size of the injury. They can form more commonly in younger persons, those with darker skin tones, or that have a family history of keloid scars.

Illustration of keloid scar on woman's shoulder

How to minimise a scar?

Scars are a natural part of healing, but are often considered to be undesirable. They can affect confidence, especially when visible. If you have a wound or incision that is healing up, then there are things you can do to ensure a safer, faster healing process. A well-healed wound may result in a far less noticeable scar.

To minimise a scar:

  • Keep the wound clean during healing. Infection can delay healing, make the wound worse, and increase scarring.
  • Keep the wound protected. This may vary depending on what has caused the injury or wound. Follow medical advice for ‘dressing’ (covering) the wound appropriately. Silicone gels are sometimes used as they can protect the wound from bacteria, and keep the skin soft whilst it heals.
  • Moisturise the skin. Keep newly healed skin hydrated and supple by applying appropriate moisturising products. Consult your pharmacist if you aren’t sure which to use.
  • Eat a well balanced diet. Ensuring your diet contains enough minerals, vitamins and protein.
  • Avoid activities that ‘pull’ or stretch the scar as it is healing.
  • Wear sun protection. Scar tissue and newly-healed skin is very sensitive to the sun’s rays, so keep them covered from sun exposure wherever possible. Use SPF if it’s not possible to keep them covered.

Treatments for scarring

Once a scar has fully healed, there are a number of options to treat the appearance of the scar if it is causing you distress. Some scars can impact movement and mobility, and cause pain or discomfort.

Scars may also have an emotional or psychological impact, which can be a very important part of your treatment. Be sure to chat to your doctor if you have scarring that is bothering you, affecting your confidence or stopping you from going about your regular activities.

Treatment for scars may include: 

  • Over the counter medications and scar treatments. These are typically used to relieve itching and sensitivity, as well as improving the appearance of scarring.
  • Dressings. These can take the form of silicone sheets, medicated dressings, or pressure dressings. Pressure dressings are worn for long periods of time, and can help in the management and healing of large scars such as burn scars.
  • Steroids. Your doctor may be able to prescribe a type of steroid cream that can lessen the appearance of scars. Steroids can also be injected to treat some forms of keloid and hypertrophic scars as well as applied topically.
  • Camouflage makeup. Using makeup to conceal or minimise the appearance of scars is a popular and accessible option for many. Special types of makeup can be used, and in some cases it is available on the NHS
  • Laser treatment. Laser treatment is sometimes used to flatten the appearance of scars and even out the skin’s colour and texture. Make sure you research and choose an experienced practitioner.
  • Surgery. A more invasive option that should be discussed with your doctor or dermatologist.

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Scars are normal, and are a natural part of skin healing. But, that doesn’t mean they can’t be treated. Even as a wound is healing, there are steps that can be taken to minimise the impact of scarring. Older scars may still benefit from treatment and skin care. Remember to protect scars from the sun and keep skin hydrated and protected – whatever stage of healing you’re in. If you are living with acne, and are concerned about the impact of potential scarring, read more about how acne treatments can help.

References

www.nhs.uk/conditions/scars
www.nhs.uk/conditions/keloid-scars
www.hey.nhs.uk/patient-leaflet/scar-information
www.nhs.uk/conditions/scars/treatment