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Scars

Formation and types of scars 

Scars are like a mirror of our lives. They are a visible sign of traumatic experiences and accidents that one has survived, but they can also tell a story about crises that were overcome and important turning points in a person’s life. Learn here about what a scar actually is, how scars form and what types of different shapes scars can take on.
 

Definition: What a scar is  

Scars form after skin is injured. Generally speaking, the term scar is used to describe either a closed wound that is undergoing a healing process or any visible traces of a wound that has already healed.
In medical terms, a scar is simply coarse and fibrous replacement tissue. This tissue is formed by connective tissue cells during the healing process in order to close up gaps that form in the skin after an injury. A distinction is made between active or immature scars and mature scars.

Scar formation: Why do scars form?

Every skin injury leaves behind marks in the form of scars. If an injury is only superficial or minor, these scars are often barely noticeable. If a large section of the skin is affected or the injury extends to the deep layers of the skin, this can lead to very distinct scars and noticeable hindrances in day-to-day life. Every person deals with their scars differently, with the story behind the scars playing a major role here. The aim of scar therapy should not just be to regain mobility, but also to restore aesthetics. Be they large or small, scars can have a major effect on a person’s quality of life. That’s why it makes sense to treat scars, and especially fresh ones, as the chances of being able to influence scar quality in a positive manner are particularly favourable in the early stages of scar formation.

 

Woman with a Juzo ScarPrime Light sleeve

There are all different kinds of causes of skin injuries that lead to scar formation during the healing processes. A distinction is primarily made here between traumatic wounds caused by external force and iatrogenic wounds that occur as a result of medical treatment.


Skin injuries

Traumatic wounds in turn are divided into 4 sub-groups.

Iatrogenic wounds occur as a result of medical treatment , whether in the form of surgery or diagnostic or therapeutic procedures.  

 

  • Surgical incisions
  • Punctures
  • Laser treatments
  • Split-thickness skin grafts
  • Removal of melanoma and other skin changes
  • Transplant and amputation wounds

Formation of scars

If our skin is damaged, our organism tries to repair it. The primary task of newly formed tissue here is to close the wound quickly in order to prevent foreign substances and pathogens from entering the body. In terms of appearance and functionality, however, scar tissue does not display the characteristics of the original skin. For example, it’s not as soft, it’s less elastic and it dries out more quickly than normal skin. In the case of superficial injuries that only affect the epidermis, wounds can heal completely without leaving any marks (epithelial wound healing). These types of injuries to the epidermis include sunburn and superficial abrasions. If deeper layers of skin are affected, such as in the case of surgeries etc., scars are formed after the various stages of wound healing. The wound healing process depends on the type, size and depth of a wound, but also on the genetic make-up of  the person in question.

Man and woman with a ScarPrime Light garment

If one wants to understand how scars form, it’s helpful to take a closer look at the basic characteristics and functions of the skin, as well as the wound healing phases of the skin in connection with an injury.


Interesting facts about our skin

The skin: A true all-rounder

With a total area of between 1.5 and 2 square metres, the skin is the human body’s largest organ. It also has the greatest number of nerves and accounts for up to 20% of body weight. The skin performs numerous complicated bodily functions such as regulating heat, protecting the body against infections and environmental influences, and preventing the body from drying out. It thus helps maintain the body’s inner balance and the exchange of substances within the body and its cells.    

Yet skin is much more than “just” an organ, as skin is also our contact with the outside world – it has a representative function and serves as a protective barrier and even a communication tool. All types of touch are sensed by the skin’s surface, and this surface is also a means of perceiving and expressing sensations and feelings. Indeed, there’s a reason why we refer to skin as the “mirror of life”. Many changes in one’s body, personal lifestyle and mood, as well as hormone fluctuations, become visible in the skin. 

How is skin structured?

The structure of skin is complicated. The skin’s structure is the same throughout the entire body. The skin consists of three layers: the epidermis, the dermis and the subcutis. These layers have different functions. The thickness of the skin differs depending on the area of the body. Skin on your face or the back of your hand is much thinner than that on your thigh, for example. The number of hair roots and sensory cells, such as temperature, pain and touch receptors, also varies. 

Layers of the skin

Good to know

  • A baby’s skin is around 20 to 30% thinner than an adult’s. Although it comprises the same number of skin layers, the individual layers are considerably thinner, making it especially delicate and sensitive. 
  • Female skin has a different composition than male skin, with a man’s epidermis being a lot thicker compared to its counterpart in women. Its connective tissue is also networked more intricately and contains considerably smaller fat deposits.

The wound healing phases of a scar

Good to know

 

  • If an injury affects only the first layer of the skin (epidermis), the wound will fully heal without leaving any scar tissue behind. This is referred to as regenerative healing.
     
  • Scar tissue can change for up to two years after its formation. During this time, scar therapy can have a positive effect on the development of a scar. The therapy can somewhat reduce itching and pain, especially in the early stages of scar formation, i.e. in the case of immature scars.

How is skin structured?

Overview of scar types

Scars are generally divided into three sub-groups based on their characteristics.


Burns and scars 

Burns usually lead to raised hypertrophic scars. However, depending on how they develop, they can also result in sunken atrophic scars, or keloids. Burns are divided into three degrees based on the severity of the burn in question. In the case of first-degree burns, only the first layer of the skin is affected and the burn scars can usually heal completely. Second-degree burns involve the formation of burn blisters, whereby the middle layer of the skin is also affected here. Second-degree burns are also subdivided into second-degree 2a and 2b burns, whereby second-degree 2a burns can heal on their own, while second-degree 2b burns require surgery. Third-degree burns destroy the lowermost layer  of the skin. Many burn scars also develop into sclerotic scars.  

Sclerotic scars  

In the case of sclerotic scars, the connective tissue that forms shrinks and contracts. This leads to the formation of hardened rigid scars that are not sufficiently elastic and can therefore also lead to noticeable limitations in terms of physical functionality. This is why the treatment of sclerotic scars focuses on the recovery of mobility.


Scars can change

No two scars are the same. If you were to monitor the healing of two identical wounds on different people, the resulting scars would not be exactly the same. A scar, and its appearance and development, depends on all manner of factors – some of which can be influenced.

Factors that can be influenced

Mobilisation
Depending on the type and severity of an injury that leads to the scarring, passive movement by a therapist may be necessary. Mobilising the scar and the surrounding areas increases circulation and makes the connective tissue looser, softer and more supple, thereby improving the quality of the scar.

 Avoiding the sun
Fresh scars should never be directly exposed to the sun, otherwise they may darken. You should always be sure to cover yourself with sun-protective clothing or compression garments and/or sun cream.

 
Compression therapy
Wearing compression garments every day has a positive effect on the quality of a scar and can support healing and prevent an overgrowth of scar tissue.
Further information on compression therapy

 
Silicone products and ointments
Using silicone products and special ointments has a positive effect on scar tissue. Such products keep scar tissue moist and supple and can support healing.
Further information on silicone products

 

Fixed factors

Location
Scars on parts of the body that are often moving are constantly under strain. The continuous tension can lead to the development of undesirable scar formations.
 

Age
Wound healing is often impaired in elderly people, owing to a change in skin structure. Skin becomes less elastic, there are fewer layers of fat and the blood supply decreases. Children and young people tend to have thicker and more bulging scars as there is often an overproduction of new connective tissue.
 

Skin thickness
Thicker skin forms more visible and distinct scars. Skin thickness starts to increase in childhood and then decreases again from the age of 65.
 

Skin type and origin
People of African or Asian descent are prone to scarring and an overgrowth of scar tissue resulting from an excessive production of new connective tissue.
 

Other illnesses
Accompanying illnesses or pre-existing conditions (impaired circulation, diabetes, etc.) negatively affect scarring.
 

Important

Scar tissue can change for up to two years after its formation. During this time, it is possible to exert a positive effect on the development of a scar by ensuring the right care and treatment. Find out more now about how scars are treated.