Understanding scars and effective care

When you get a cut or wound, your body naturally starts to heal itself. Initially, a scab forms to protect the area, but it's not very strong. Over time, the healing process goes through three phases and can lead to scarring that takes some time to heal.

We’re taking a closer look at these phases and what scar treatment can best help the healing process, as well as those difficult to heal scars – hypertrophic and keloid scars.

Three phases of healing and scarring

1) Initial inflammatory phase

This is when your body's natural response kicks in. Right after injury, blood vessels contract to form a clot, and then they dilate to allow important nutrients, white blood cells, and antibodies to reach the area and start repair.

2) Proliferation phase

During this phase, new skin starts to form with the help of collagen-rich tissue. The appearance of the wound during this phase indicates how well it's healing.

3) Maturation or remodelling phase

This is the final stage of healing where the scar flattens and becomes softer as some collagen disappears. This phase can last for 12 to 18 months or longer.

The healing process isn’t always straightforward, and the wound may go back and forth between the second and third phases. Ideally, the wound should heal from the deeper layers to the surface layers, which takes time and optimal conditions.

What is a scar?

A scar is a raised area of thickened skin that remains after a wound has healed. Scarring is a natural part of tissue repair, and it can take up to two years for a scar to fully settle and look like normal skin again.

Keeping the scar regularly moisturised and gently massaging it, can help reduce its appearance over time.

Difficult-to-heal scars

Some scars don't heal well and can grow beyond the normal skin area and the original injury site. There are two main types of difficult-to-heal scars: hypertrophic scars and keloid scars.

1) Hypertrophic scars

These scars usually occur when the deeper layer of skin called the dermis is damaged. They appear as red, raised, and thick scars.

Hypertrophic scars typically settle on their own within one to two years and usually don't spread beyond the original injury area.¹

2) Keloid scars

Keloid scars on the other hand, tend to extend beyond the original wound boundaries and are the result of excess collagen being produced at the site of a wound.¹

They can remain elevated, become shiny, hairless, hard, and rubbery, and change colour over time, they can also keep growing even after the wound has healed.

While keloid scars may improve in appearance, they are unlikely to disappear completely and restrict movement if they’re near a joint.

How to help reduce the appearance of scars

To reduce the appearance of scars, it's important to keep the skin moisturised. It is also recommended that you:

• Keep the wound clean and protected. Use sterile dressings and avoid pulling or stretching the skin around the wound.
• Protect your scar from the sun. Cover it with clothing or use a sunscreen with SPF 30 or higher for at least a year, as sun exposure can darken scars and make them more noticeable.²
• Moisturise regularly. Use emollients like Aveeno bath oil, aqueous cream, or Cetraben to keep the skin soft and hydrated.
• Use silicone gels or sheets. These specially designed products can help flatten and soften scars, especially hypertrophic and keloid types.
• Gently massage the scar. This can improve flexibility and help the scar blend in better over time.
• Avoid picking or scratching. Let the wound heal naturally to prevent infections or worse scarring.
• Seek professional advice. If your scar is painful, itchy, growing, or bothering you emotionally, consult your healthcare provider. Treatments like steroid creams, injections, or laser therapy may be recommended.

When to consider surgery for scars

In more extreme cases, surgery may be used to make the scar appear more natural or less noticeable, for example by using a skin graft from an area of healthy skin to cover the damaged tissue.

Surgery may also be used if the scar tissue is restricting your movement in any way.³

Remember, scars take time to heal and fade. Be patient and consistent with the process and follow the recommendations of your healthcare provider. By caring for your scars properly, you can help minimise their appearance and support the healing journey.

References

1. Scars – NHS factsheet
2. Scars – NHS
3. Surgical Interventions – Dermatologists.org