Scar

All scarring is composed of the same collagen as the tissue it has replaced, but the composition of the scar tissue, compared to the normal tissue, is different. unlike normal tissue which distributes fiber elasticity. Scars differ in the amounts of collagen overexpressed. Labels have been applied to the differences in overexpression. Two of the most common types are hypertrophic and keloid scarring, Hypertrophic Hypertrophic scars occur when the body overproduces collagen, which causes the scar to be raised above the surrounding skin. Hypertrophic scars take the form of a red raised lump on the skin for lighter pigmented skin and the form of dark brown for darker pigmented skin. They usually occur within 4 to 8 weeks following wound infection or wound closure with excess tension and/or other traumatic skin injuries. Keloid Keloid scars are a more serious form of excessive scarring, because they can grow indefinitely into large, tumorous (although benign) neoplasms. Keloid scars can occur on anyone, but they are most common in dark-skinned people. They can be caused by surgery, cuts, accident, acne or, sometimes, body piercings. In some people, keloid scars form spontaneously. Although they can be a cosmetic problem, keloid scars are only inert masses of collagen and therefore completely harmless and not cancerous. However, they can be itchy or painful in some individuals. They tend to be most common on the shoulders and chest. Hypertrophic scars and keloids tend to be more common in wounds closed by secondary intention. chickenpox, other diseases (especially Staphylococcus infection), surgery, certain insect and spider bites, or accidents. It can also be caused by a genetic connective tissue disorder, such as Ehlers–Danlos syndrome. Stretch marks Stretch marks (technically called striae) are also a form of scarring. These are caused when the skin is stretched rapidly (for instance during pregnancy, significant weight gain, or adolescent growth spurts), or when skin is put under tension during the healing process (usually near joints). This type of scar usually improves in appearance after a few years. Umbilical Humans and other placental mammals have an umbilical scar (commonly referred to as a belly button or navel) which starts to heal when the umbilical cord is cut after birth. Egg-laying animals have an umbilical scar which, depending on the species, may remain visible for life or disappear within a few days after birth. == Pathophysiology ==

A scar is the product of the body's repair mechanism after tissue injury. If a wound heals quickly within two weeks with new formation of skin, minimal collagen will be deposited and no scar will form. When the extracellular matrix senses elevated mechanical stress loading, tissue will scar, Small full thickness wounds under 2mm reepithelize fast and heal scar free. Deep second-degree burns heal with scarring and hair loss. Sweat glands do not form in scar tissue, which impairs the regulation of body temperature. Elastic fibers are generally not detected in scar tissue younger than 3 months old. In scars, rete pegs are lost; The endometrium, the inner lining of the uterus, is the only adult tissue to undergo rapid cyclic shedding and regeneration without scarring, shedding and restoring roughly inside a 7-day window on a monthly basis. All other adult tissues, upon rapid shedding or injury, can scar. Prolonged inflammation, as well as the fibroblast proliferation, Scars form differently based on the location of the injury on the body and the age of the person who was injured. The more severe the initial damage is, the more significant the scar will generally be. Skin scars occur when the dermis (the deep, thick layer of skin) is damaged. Most skin scars are flat and leave a trace of the original injury that caused them. Wounds allowed to heal secondarily tend to scar more significantly than wounds from primary closure. Collagen synthesis An injury does not become a scar until the wound has completely healed; this can take many months, or years in the worst pathological cases, such as keloids. To begin to patch the damage, a clot is created; this clot is the beginning process that results in a provisional matrix. In the process, the first layer is a provisional matrix and is not a scar. Over time, the wounded body tissue overexpresses collagen inside the provisional matrix to create a collagen matrix. This collagen overexpression continues and crosslinks the fiber arrangement inside the collagen matrix, making the collagen dense. This densely packed collagen, morphing into an inelastic whitish collagen To mend the damage, fibroblasts slowly form the collagen scar. The fibroblast proliferation is circular Myofibroblast Mammalian wounds that involve the dermis of the skin heal by repair, not regeneration (except in 1st trimester inter-uterine wounds and in the regeneration of deer antlers). Full-thickness wounds heal by a combination of wound contracture and edge re-epitheliasation. Partial thickness wounds heal by edge re-epithelialisation and epidermal migration from adnexal structures (hair follicles, sweat glands and sebaceous glands). The site of keratinocyte stem cells remains unknown but stem cells are likely to reside in the basal layer of the epidermis and below the bulge area of hair follicles. The fibroblast involved in scarring and contraction is the myofibroblast, The myofibroblasts are absent in the first trimester in the embryonic stage where damage heals scar-free; and is responsible for fibrosis on tissue. Generally, the myofibroblasts disappear from the wound within 30 days, Myofibroblasts have plasticity and in mice can be transformed into fat cells, instead of scar tissue, via the regeneration of hair follicles. ==Mechanical stress==

Wounds under 2 millimeters generally do not scar, == Treatment ==

Early and effective treatment of acne scarring can prevent severe acne and the scarring that often follows. In 2004, no prescription drugs for the treatment or prevention of scars were available. Chemical peels Chemical peels are chemicals which destroy the epidermis in a controlled manner, leading to exfoliation and the alleviation of certain skin conditions, including superficial acne scars. Various chemicals can be used depending upon the depth of the peel, and caution should be used, particularly for dark-skinned individuals and those individuals susceptible to keloid formation or with active infections. Filler injections Filler injections of collagen can be used to raise atrophic scars to the level of surrounding skin. Risks vary based upon the filler used, and can include further disfigurement and allergic reaction. Laser treatment Nonablative lasers, such as the 585 nm pulsed dye laser, 1064 nm and 1320 nm Nd:YAG, or the 1540 nm Er:Glass are used as laser therapy for hypertrophic scars and keloids. There is tentative evidence for burn scars that they improve the appearance. Ablative lasers such as the carbon dioxide laser (CO) or Er:YAG offer the best results for atrophic and acne scars. Like dermabrasion, ablative lasers work by removing the epidermis. Healing times for ablative therapy are much longer and the risk profile is greater compared to nonablative therapy; however, nonablative therapy offers only minor improvements in cosmetic appearance of atrophic and acne scars. Dressings and topical silicone Silicone scar treatments are commonly used in preventing scar formation and improving existing scar appearance. A meta-study by the Cochrane collaboration found weak evidence that silicone gel sheeting helps prevent scarring. Pressure dressings are commonly used in managing burn and hypertrophic scars, although supporting evidence is lacking. Care providers commonly report improvements, however, and pressure therapy has been effective in treating ear keloids. Gross morphologic features suggested that the combination of verapamil and silicone improves the overall quality of hypertrophic scars by reducing scar height and redness. This was verified with quantifiable histomorphometric parameters; however, oral verapamil is not a good choice because of its effect of lowering blood pressure. Intralesional injection of verapamil is also suboptimal because of the required frequency for injections. Topical silicone gel combined with verapamil does not lead to systemic hypotension, is convenient to apply, and shows enhanced results. Topical steroids are ineffective. However, clobetasol propionate can be used as an alternative treatment for keloid scars. Topical steroid applied immediately after fractionated laser treatment is however very effective (and more efficacious than laser treatment alone) and has shown benefit in numerous clinical studies. Surgery (left), and photo one day after scar revision surgery: The area around sutures is still swollen from surgery. Scar revision is a process of cutting the scar tissue out. After the excision, the new wound is usually closed up to heal by primary intention, instead of secondary intention. Deeper cuts need a multilayered closure to heal optimally, otherwise depressed or dented scars can result. Surgical excision of hypertrophic or keloid scars is often associated to other methods, such as pressotherapy or silicone gel sheeting. Lone excision of keloid scars, however, shows a recurrence rate close to 45%. A clinical study is currently ongoing to assess the benefits of a treatment combining surgery and laser-assisted healing in hypertrophic or keloid scars. Subcision is a process used to treat deep rolling scars left behind by acne or other skin diseases. It is also used to lessen the appearance of severe glabella lines, though its effectiveness in this application is debatable. Essentially the process involves separating the skin tissue in the affected area from the deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area. Once the skin has leveled, treatments such as laser resurfacing, microdermabrasion or chemical peels can be used to smooth out the scarred tissue. Vitamins Research shows the use of vitamin E and onion extract (sold as Mederma) as treatments for scars is ineffective. Other • Cosmetics; Medical makeup can temporarily conceal scars. This is most commonly used for facial scars. • Dermabrasion involves the removal of the surface of the skin with special equipment, and usually involves a local anaesthetic. • A 2012 literature review found weak evidence that massage was efficacious in scar management. Any beneficial effect appeared to be greater in wounds created by surgical incision than for traumatic or burn wounds. A 2022 scoping review covering twenty-five studies of 1515 participants reported that all studies reviewed reported favorable outcomes for scar massage, but that "while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics", there was a lack of "consistent research methods, intervention protocols and outcome measures". • Microneedling ==Society and culture==

Intentional scarring The permanence of scarring has led to its intentional use as a form of body art within some cultures and subcultures. These forms of ritual and non-ritual scarring practices can be found in many groups and cultures around the world. Etymology First attested in English in the late 14th century, the word scar derives from a conflation of Old French escharre, from Late Latin eschara, which is the Latinisation of the Greek ἐσχάρα (eskhara), meaning "hearth, fireplace", but in medicine "scab, eschar on a wound caused by burning or otherwise", and Middle English skar ("cut, crack, incision"), which is from Old Norse skarð ("notch, gap"). The conflation helped to form the English meaning. Compare the place name Scarborough for evolution of skarð to scar. ==Research==

Research, before 2009, focused on scar improvements with research into molecular mechanisms. Treatments involving molecular mechanisms including avotermin, ribosomal s6 kinase (RSK), and osteopontin were investigated at the time. After successful phase I/II trials, In 2011, the scientific literature highlighted stress shielding a fresh wound through the wound healing process, brings significant scar improvement and smaller scars. By 2016, skin had been regenerated in vivo and in vitro. and scar-free healing had been operationalized and induced by four main regeneration techniques: by instrument, by materials, by drugs, and by in vitro 3-D printing. In 2018, a silk-derived sericin hydrogel dressing was undergoing research, the material was shown to prevent scar formation. By 2021, more people were paying attention to the possibility of scar revision and new technologies. In 2021, researchers found that, verteporfin, an FDA-approved drug for eye disease, could enable scar-free healing in mice. According to the study, the drug works by blocking mechanical stress signals in fibroblast cells. == See also ==