A scar is a fibre-rich replacement tissue formed by connective tissue cells during wound healing. Scarring is a natural process that occurs when injured tissue heals. A scar occurs when not only the top layer of skin (epidermis) but also deeper layers of skin are injured. Scars are final but not immutable. Just as different as the types of scars are their healing and care processes.
How is a scar created?
Scar formation is the final step in wound healing, which is divided into three stages: Inflammation, repair and reconstruction phase. External scars usually develop after injuries to deeper layers of the skin. A small cut or superficial laceration often only injures the top layer of skin (epidermis). In this case, starting from the lowest, so-called basal cell layer of the epidermis, a new, intact skin layer forms, which closes the resulting wound.
What types of scars are there?
Depending on the type of injury, the condition of the wound edges, wound hygiene, but also on age and genetic factors, different visible scars can remain after an injury. A distinction is made between the following types of grain:
- Hypertrophic scars
- Keloid scars or proliferating scars
- Hypotrophic (atrophic) / sunken scars
- Sclerotic scars
- Unstable scars
Hypotrophic scars (atrophic)
Hypotrophic scars are caused by the deficient formation of connective tissue. The term “atrophy” denotes a regression. In atrophic scars, the wound closes after healing, but the skin does not form enough new connective tissue to fill the wound. This creates sunken scars, the bottom of which is deeper than the surrounding skin. These scars are therefore usually found flat and in the form of small dimples. The wound tends to heal poorly because the formation of new connective tissue fibres is not sufficient. The sunken scar is therefore below the level of the skin, which is especially the case with acne scars. Stretch marks in bodybuilders or stretch marks in pregnancy are also atrophic scars.
Hypertrophic scars are raised scars which, in contrast to hypotrophic scars, are caused by an excessive formation of connective tissue. They are often the result of an injury that was stressed too early or an ongoing infection. Hypertrophic scars thus often develop when the wound has to close against strong tensile forces during healing and is thus exposed to constant movement or stress. The constant tension causes more blood vessels and connective tissue to form, which often makes hypertrophic scars appear very bulging and very red. They can also be itchy and sometimes painful. However, they remain limited to the original injury area, but protrude above the skin level. The scar growths develop directly within the first few weeks after the injury and not at a later time.
Keloid scars or keloids are proliferating scars that form some time after wound closure due to an overproduction of connective tissue. Keloids are thick, curved, often very red, appear darker than the surrounding tissue and extend beyond the original area of injury. They are therefore often called “wild flesh” because they are not limited to the area of the wound, but often extend tumour-like to the neighbouring, healthy skin tissue. This also often causes itching. Especially young women and people with dark skin are affected by keloids. They only occur in pigmented skin and often develop on shoulders or earlobes. Burn wounds also often form keloids.
Sclerotic scars form after extensive injuries such as burns. They arise from the formation of new hard and dry tissue. During healing, the tissue contracts strongly, which is why the skin becomes hard and inelastic. Sclerotic scars also tend to shrink. If they lie over joints, they can cause contractures or immobilisation, which is why surgical correction is often advisable.
Unstable scars are usually the result of poorly functioning wound healing. It often affects areas of the body where the skin is exposed to frequent tension. This includes, for example, the skin on the joints. Typical symptoms of unstable scars are, among other things, ulcers and tears that form again and again. It is imperative that this type of scar is treated professionally, because there is a risk that a malignant carcinoma will develop.
What should absolutely be avoided in order for a scar to heal well?
Wound and scar healing depends on a wide variety of factors and can therefore vary from person to person. In order for a scar to heal well, contamination of the wound area, tension and irritation caused by tight-fitting clothing, and re-injury should be avoided. In addition, care should initially be taken to ensure that the scar is not exposed to strong temperature stimuli or extreme sunlight.
When are the sauna, steam bath and swimming pool allowed again?
As a general rule, you should not go into the sauna, steam bath or swimming pool again until the wound has completely healed. In the case of scars after surgical procedures, this means that there are no more foreign bodies such as sutures or staples in the scar and that it has healed completely smoothly and free of crusts. If this is not the case, you run the risk of catching a serious infection.
When can the scar be exposed to direct UV radiation or the solarium?
Since the scar tissue has no pigment-forming cells, it cannot protect itself from UV rays by tanning. Scar tissue stands out from tanned skin in a radiant white and suffers from UV damage in the process. Therefore, direct sunlight as well as visits to sunbeds should be avoided for six months to a year after the wound has healed and a high sun protection with at least SPF 50 should also be applied to the scar afterwards.
In order to support the healing process of a scar, it is recommended to care for the scar properly, depending on its type and characteristics. This is because scar care can help the scar become paler, smoother and also flatter by stimulating blood circulation. Even older scars can still respond to scar care, provided the right product is used. Thus, proper scar care can prevent pathological scars from forming, such as hypertrophic scars or keloids. Unfortunately, scar care takes a lot of patience and is not done in just a few days. For special care products to work, they should normally be used for several months.
When should scar treatment be started?
In order for scar care to have the best effect after an operation or injury, it should be started as early as possible. In the early stages, the scar is still in the process of remodelling and therefore more receptive to treatment. As soon as the wound is closed or the doctor has removed the stitches, you can start caring for the fresh scar. However, this should always be discussed with the attending physician beforehand.
How does scar care work?
A wound that is not yet completely closed is best treated with healing ointments to support wound healing. Once the wound is completely closed, special products can be used for scar care. For example, silicone-containing gels and plasters are suitable for this. In addition, it is partly possible to support the process of scar formation and healing with massages. The scar should be stressed as little as possible. Regular massages and care with ointments and oils can prevent dehydration, redness and growths.
How long should the scar be tended for?
Basically, the earlier you start to care for the scar, the better. Fresh scars should be cared for at least eight weeks, older scars even up to six months. The healing time of an injury and the duration of care for the resulting scar depend on the extent and severity of the injury. If only the epidermis is injured, the skin can renew itself on its own within 28 days. In most cases, no scar remains and the duration of care is correspondingly shorter.
Which products can be used?
As soon as the wound edges are completely closed and the stitches of surgical scars are removed, the scar should be applied with special creams and gels once or twice a day. Products with active ingredients such as heparin, dexpanthenol and allantoin, as well as silicone-based products, are particularly effective. They help reduce redness, soften scar tissue, relieve pain and itching, reduce inflammation and moisturise. In addition, when used correctly, you can reduce/prevent the growth of excess connective tissue of the scar. All products have moisture and fat as ingredients in common – this is the most important thing for the scar – regardless of manufacturer or marketing.
Ointments consist of a single-phase base, do not contain water and normally do not need to be preserved. Cream, on the other hand, is a multi-phase system that always contains emulsifiers and must be preserved. There are both lipophilic (fat-loving) and hydrophilic (water-loving) creams. Gels consist of a liquid phase that is thickened with a gelling agent. This creates a three-dimensional gel structure. Both should be applied to the affected skin area over several weeks, at least twice a day, and massaged in gently. Scar gels are suitable for both fresh and older scars. The attending physician can best explain which scar care is most suitable for the individual situation.
What is a scar plaster?
Scar plasters are made of a special material that is breathable and permeable to water vapour. This creates a skin climate in the scar area that stimulates the metabolic processes and promotes cell formation.
In addition, scar plasters exert a slight pressure on the wound, which helps keep the tissue under the plaster supple. This makes the scar flatter, lighter and more elastic. Scar plasters thus protect against excessive scarring and are therefore popular for treating hypertrophic (bulging) scars. They can also lighten older scars and reduce excess scarring to a certain extent.
They should only be applied after wound healing is complete and are stuck directly over the scar. To achieve their full effect, the patches should remain on the scar for at least twelve hours. Treatment with scar plasters usually lasts two to three months. As they do not contain any active pharmaceutical ingredients, there are usually no side effects and they are therefore also very suitable for people with allergies, pregnant women as well as children and people with sensitive skin. However, caution is advised with allergies to silicone.
Can home remedies for scar care also be used?
Herbal skin oils are also suitable for scar care, as they have valuable ingredients that can have a positive effect on the healing process of the scar. Above all, vitamin E and vitamins of the A group are contained in almost all natural oils. They support the skin in regeneration and increase its elasticity. St. John’s wort, grape seed, marigold, almond or jojoba oil are particularly good for scar care. Such oils stimulate blood circulation and make the scar fade. In addition, they keep the skin elastic and supple and partly also have an anti-inflammatory effect. When using vegetable oils, however, it is also important to avoid direct sunlight, as otherwise unsightly discoloration can occur in the scar area.
How can scars be corrected?
There are many ways to correct scars. In many cases, the treating doctor uses several procedures to correct the scar. In addition to natural remedies and medical methods for scar care and correction, surgical procedures can also help to correct or even completely remove the scar. The doctor must always decide individually which method is best suited for the respective scar. Surgical correction is necessary for some more severe scars. Other scars can be corrected with laser treatment, chemical peeling or hyaluronic acid/platelet-rich plasma (PRP). For more information about the correction of scars, we recommend that you take a look at our page in the Gynaesthetic section.