Types of Scars - LIVING WITH SCARS

We all have them – scars.

Some scars are tiny remnants of our childhood adventures and you simply smile when you see them – as the memories of fun-filled childhood activities are usually warm and fuzzy, and some scars are significant markers of the challenges life has put us through. Whichever scars you have, it is good to know the differences between the different types of scars and how to improve their look.

What are Scars and how are they formed?

Scars are the visible marks on the skin that appear after the healing of a laceration or injury. Scarring is part of the body’s natural healing process after skin tissue is damaged. When tissue is damaged and breaks, this causes a protein called collagen to be released.

Collagen is the most copious protein in the body of mammals and is found in the body’s innumerable connective tissues. It is the main component of connective tissues and makes up about one-third of its protein composition. It plays an indispensable protective role in the human body and is abundant in the skin, tissues, cartilage, and bones.

When the skin is wounded, tissues break, which causes the collagen protein to be released. Collagen builds up at the site of the tissue damage doing its role to heal and strengthen the damage caused by the wound. Collagen continues forming for several months, increasing the blood supply around the wound which is what causes the scar to become raised and lumpy.

Over time, collagen begins to break down, reducing the blood supply to the affected area and, depending on the type of scar, it will gradually become smoother although will not completely fade.

What are the different types of Scars?

As there are various reasons or methods for how a scar can be caused, there are also different types of scars. Scars can appear as a pitted hole in the skin, a fine line or shape depending on the injury caused or scars can even be caused by abnormal tissue overgrowth. Scars may develop anywhere on the body and vary depending on their structure. Below we explore the different types of external scars in more detail.

Fine-Line Scars

The most common scars for people to endure would be the normal, fine-line scars. These appear after a minor injury, such as a cut, that heals and gradually leaves behind a small imprint of the wound that will gradually flatten and fade over time. The amount by which it will fade would be dependent on the depth and severity of the injury or wound. A fine-line scar may never truly fade, but these scars are not usually painful, although they may feel itchy for some time after the healing process.

Keloid Scars

Keloid scars can be identified by being purple or red in color and give the appearance of a raised surface above the skin. This occurs when there is an excess in collagen production at the site of the initial wound. This excess leads to tissue overgrowth above the skin level, which is the cause of the raised appearance of the scar on top of the skin. The most identifying factor of a keloid scar is that even after the wound is healed, the scar can grow larger than the original size of the wound. Keloid scars can bring discomfort through pain or itchiness, especially when formed near a joint as this may restrict movement.

Hypertrophic Scars

Hypertrophic scars are similar to keloid scars in that they too are formed as a result of excess collagen production at the site of the wound or injury. However, unlike keloid scars, they do not continue to grow beyond the boundary of the original wound or injury. They appear on the wound site in a raised and discolored form, usually red in color, and also cause discomfort. Hypertrophic scars may continue to become thick in appearance for several months after the initial injury.

Atrophic Scars

Atrophic scars differ from both keloid and hypertrophic scars in that they are indented in their appearance and develop below the skin’s surface, which produces a sunken appearance in the area affected. These scars may become more prominent over time due to the body’s aging process. Atrophic scars develop when the skin is unable to regenerate tissue properly. Their indented appearance is due to the healing process occurring below the skin layer. These scars are commonly linked to severe acne or chickenpox, although they could also be the result of mole removal.

There are three particular types of atrophic scars:

those with a deep pore appearance that is a result of severe acne are called icepick scars
the flat-bottomed scars that bear a resemblance to chickenpox scars are called boxcar scars
those that are identified through a lack of distinctive edges and are usually located on the cheeks are called rolling scars.

Acne Scars

Acne scars may either be hypertrophic or atrophic scars. In many places across the globe, acne is one of the most common skin-related concerns reported by young adults and teens. Pimples (acne) occur when the skin pores are clogged by dead skin cells, dirt, and oil. This build-up enables bacteria to grow and causes pus to form. The inflammation of the sebaceous glands (the skin’s oily glands) contains fatty substances called sebum, which block the pore’s oil ducts.

Acne ranges from mild to severe cases, and when not healed properly or with the proper treatment, it can form scars that are difficult to get rid of. Acne scarring can vary depending on its location on the body. When they are on the face it looks like damage to the skin texture and appears as indentations on the face in various sizes but the same color as the skin. The scarring on the chest or back area more likely tends to be raised and lumpy.

Contracture Scars

Contracture scars are often caused by burns or through a major injury to the joints that would cause significant tissue loss. This occurs when the skin “shrinks” or pulls together from the burn during the healing process, which could lead to tightness and restriction of movement. These scars are more severe and appear as fixed scars which can cause both functional and cosmetic concerns.

Stretch Marks

Stretch marks can be considered scars due to the visible mark it leaves on our bodies. They are caused by a break in the connective tissue, which occurs when our skin rapidly shrinks or grows in a short period of time. They appear as streaks on the skin that are mildly indented and are often located on the buttocks, thighs, abdomen, and breast. Their occurrence is commonly associated with pregnancy, rapid weight loss or gain, and bodybuilding. When they first appear on the skin, they may be a little itchy and red in color, which will gradually fade away to become indented scarring, usually multiple scars in the affected area.

Burn Scars

Burn scars happen if your skin comes into contact with something hot, like grabbing a pan right out of the oven, or getting scalded with boiling water can burn your skin. Moreover, chemicals, the sun, radiation, and electricity can also cause skin burns.

When burns happen they cause your skin cells to die. Damaged skin produces a protein called collagen to repair itself. When the damaged skin starts healing, thickened, discolored areas called scars form. Some of these scars are temporary and fade over time. Others are permanent.

Scars can be small or large. Burn scars that cover a wide surface of your face or body can affect your appearance. The amount of heat and how long it stays in contact with your skin determine whether you get a scar and how big it is. Burns are usually classified by how much of your skin they affect.

You Are More than Your Scars

Although not common, there are negative side effects of scarring that can affect a person’s health. These could range from severe itching to tenderness and pain. Some scars may cause physical deformity, depending on their location on the body and severity of the original injury, which could lead to some functional disability.

Scars can also cause mental and emotional distress, which can affect your mental health in the longer term, and even cause sleep disturbances, anxiety or depression. It is important to share your concerns with a health care professional to get the help you need.

You can read my personal story of dealing with scars in my book Living With Scars.

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