Scars and the Skin Healing Process

The removal or reduction of scars, lesions, and stretch marks from the skin depends on a process called "skin remodeling".

The skin is designed to heal wounds quickly to prevent blood loss and infections. Scars are manufactured from a rapidly formed "collagen glue" that the body brings into an injured area for defense and strength. In ideal skin repairing, damaged skin is rapidly closed, and then the healed area is slowly reconstructed to remove the remaining collagen scars and blend the skin area into nearby skin.

Scar collagen is eliminated and replaced with a mix of skin cells and invisible collagen fibers. This work may continue in a skin area for up to ten years.

In children, the remodeling speed is high and scars are often rapidly eliminated from injured skin areas. But as we become adults, this rate diminishes and small scars may remain for years.

One way to accelerate repair is to induce a small amount of controlled skin damage with a needle, laser, acid, or other means, and then let the body repair processes rebuild the skin area.

A second procedure is to use enzymes and activators of skin renewal fibroblasts to increase the body's normal rebuilding processes and achieve even better final results. Fibroblasts are the cells in the basal membrane of the skin and they are the precursors of all the structural elements of healthy skin, including those that provide moisture, tensile strength and elasticity to skin. Enzymes dissolve or "digest" damaged and dying cells.

Wound Repair Process

Scars are always needed to reconnect skin that has been injured. Initially, they may be red or dark and pink after the wound has been healed but will become paler and flatter naturally over time, resulting in a flat, pale scar.

For reasons that are still waiting to be fully understood, some people form raised scars that are red and thick and may cause itch or pain. Others develop scars that grow beyond the site of an injury, called keloid scars.

Keloid scars are actually thick, puckered, itchy clusters of scar tissue that grow beyond the edges of an injury or incision and rarely regress. They occur when the body continues to produce tough, fibrous protein (known as collagen) after a wound has been repaired.

Keloids can appear after any type of injury to the skin, including scratches, injections, insect bites, tattoos or medical procedures. Keloids can appear on any part of the body, but most commonly occur on earlobes, over the breastbone and on shoulders.

Keloids are fibrotic tumors characterized by a collection of atypical fibroblasts with excessive deposition of extracellular matrix components, especially collagen, fibronectin, elastin, and proteoglycans. Histologically, keloids contain relatively acellular centers and thick, abundant collagen bundles that form nodules in the deep dermal portion of the lesion. Keloids represent a therapeutic problem that must be addressed as these lesions can cause significant pain, pruritus (itch) and physical disfigurement, may not improve in appearance over time, and can even affect mobility if located over a joint.

Hypertrophic scars use to be difficult to distinguish from keloid scars histologically and biochemically, but unlike keloids, hypertropic scars are confined to the injury site and use to mature and flatten out over time. Both types secrete larger quantities of collagen than normal scars, but typically the hypertrophic type shows less collagen synthesis after about 24 weeks. Hypertrophic scars contain about twice as much glycosaminoglycans as normal scars, and this and enhanced synthetic and enzymatic activity result in important alterations in the matrix which affects the mechanical properties of the scars, including decreased extensibility that makes them feel firm.

As with hypertrophic scarring, people having one keloid scar are likely to be prone to another one in the future and should alert their doctor or surgeon if they are going to need injections or to have any form of surgery.

Atrophic scars use to cause a thinning and diminished elasticity of the skin due to a loss of normal skin architecture. An example of an atrophic scar is striae distensae, also known as stretch marks.