Scars are a sign that nature is working at protecting us. When cell tissue gets wounded the adjacent areas of skin get working to heal the injury. Specialised cells, called fibroblasts, produce bundles of fibrous connective tissue made up of collagen to reconnect the tissue. These bundles of whitish, relatively inelastic fibres appear on the surface as a scar after the healing process has completed itself.

The deeper the wound, the greater the chances of a scar. During the process of healing, the skin creates a scab which protects the wound from germs. When the wound is healed the scab dries up and falls off, sometimes leaving behind a pale pink, brown, or silver scar, and some indentations in the skin.

How scars take shape

Following any form of skin injury – be it acne, trauma or surgery –  the healing process triggered by the wound is the same, that is, the production of collagen. The shape of the scar depends on the injury – it could even be a neat line if it was due to a surgical cut. The depth, size and location of the cut or injury also have a bearing on the type of scar. As do age, ethnicity, genes and gender. Scars are a sign that nature is working at protecting us. When cell tissue gets wounded the adjacent areas of skin get working to heal the injury. Specialised cells, called fibroblasts, produce bundles of fibrous connective tissue made up of collagen to reconnect the tissue. These bundles of whitish, relatively inelastic fibres appear on the surface as a scar after the healing process has completed itself.

The deeper the wound, the greater the chances of a scar. During the process of healing, the skin creates a scab which protects the wound from germs. When the wound is healed the scab dries up and falls off, sometimes leaving behind a pale pink, brown, or silver scar, and some indentations in the skin.

How scars take shape

Following any form of skin injury – be it acne, trauma or surgery –  the healing process triggered by the wound is the same, that is, the production of collagen. The shape of the scar depends on the injury – it could even be a neat line if it was due to a surgical cut. The depth, size and location of the cut or injury also have a bearing on the type of scar. As do age, ethnicity, genes and gender.

Scars can be of various types. Based on a thorough study of the root cause of skin damage and the type of scar, the dermatologist works out a treatment plan. Let’s understand how scars are classified.

  1. Atrophic Scars

    Scars that are sunken or have a pitted appearance with atrophy of underlying skin. These scars are formed because of the damage of collagen, elastin and the underlying fat in the affected area of the skin. Often a result of acne, chickenpox or vaccination, they appear to be depressed and punched out, or, are flat against the surface of the skin. Solutions include microneedling, lasers, peels, PRP, subcisions, radiofrequency. Treatments work best in combinations.

    Ice pick scars

    Enlarged pores create narrow marks that permeate deep into the skin. These scars are known as Ice Pick Scars because they make the skin look like it has been pierced with a sharp instrument like an ice pick. These scars are formed when acne, blackheads and whiteheads damages skin tissue deep into the lower layers of the skin.

    Box scars

    These scars, which are round or oval-shaped scars wider than ice pick scars and have steeply angled edges.Caused by the destruction of collagen in the skin tissue, they are normally a result of a severe breakout of acne and the accompanying inflammation.

    Rolling scars (wave like scars)

    Appearing as grooves that roll in wide and shallow rows over the skin, these scars occur when the epidermal layer gets pulled and damaged due to a skin infection and the skin tissue forms fibrous bands.

    Stretch marks

    Stretch marks or Striae Distance, also leave behind unsightly scars. These are atrophic, linear bands of skin that can occur when the skin is stretched, typically during pregnancy or with weight gain. Stretching damages the collagen and elastin fibres within the layers of tissue below the epidermis.Stretch marks go through two stages. Initially called Striae Rubra, they are red, pink or purple in colour. Being fresh stretch marks, they can be reduced with specially formulated creams and oils. Microdermabrasion, lasers, microneedling and PRP can also lighten these superficial scars.Left untreated, however, these purple or pink stretch marks then fade to a paler white or silverish colour – Striae Alba. These are tougher and less responsive to creams, oils and lotions. Treatment approaches would now call for carboxy therapy, laser therapy and mesotherapy. In certain cases, surgery may be suggested.

  2. Hypertrophic Scars

    Hypertrophic scars result from the excessive production of collagen at the site of the wound. However the collagen produced is less than in keloid scars (a specific form of hypertrophic scar which we’ll look at shortly), and the scars do not extend beyond the original wound. They could, however, grow for up to six months.

    These scars are red and raised initially but eventually, over the years, turn paler in colour and flatten out as well.

    These scars can also be prevented by prompt treatment of the affected area with pressure treatments and gel pads. Treatment also involves the reduction of inflammation by injecting steroids, and flattening of scars with silicone sheets. They can also be addressed surgically in a process that involves removal of excess scar tissue and repositioning of the incision so as to reduce visibility.

  3. Keloids

    Scars could extend beyond the original limit of the wound, grow thick and fibrous, and look like a tumor. Called Keloids, they result from the overproduction of tough, fibrous collagen even after the wound has healed. Acne scars on the back and shoulder are often of the keloid type.

    Keloid scars can be itchy and painful. They are often red or purple, and darker in colour than the surrounding skin when newly formed. Eventually, they become paler. If present near a joint, they may restrict its movement. Certain areas are more prone to keloids such as chest and shoulders. Studies show that ethnicity may be a contributing factor to the likelihood of scars turning keloid.

    Prompt action on fresh injury can help prevent keloid scarring. Pressure treatments or gel pads with silicone help reduce formation of keloids too.

    Cryotherapy, a freezing therapy using liquid nitrogen, can be used to treat smaller keloids. Larger keloids, however, would require flattening of the scar by steroid injections or silicone sheets. Scars can also be encased with surgery where the scar tissue is removed and the wound closed with stitches. Sometimes a skin graft is also used to diminish the appearance of the scar.

Acne? Act now.
As we have seen, a bout of acne can leave behind scars of various types. These may be of the atrophic type – box scars or ice pick. On the back or chest, acne can lead to hypertrophic keloids.

Evidently, the best way to avoid these scars is to address the triggers for an acne breakout, and treat the acne as soon as it erupts. If scars have already formed, laser treatments, peels, dermal fillers and PRP can be used to reduce them.

Scars can mar more than just a pretty face, and can run far deeper, affecting self confidence. So, it is never too early to reach out to a specialist armed with specialised tools and treatments. Rest assured, the right dermatological expertise can smooth out the bumps.

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