Why do we Scar?

Summary: Scars can appear after almost every dermal wound. While for some people they seem something trivial, some others can end with severe scarring, invalidatingdeformations and even functional alterations.

Click: Causes of Scars to read about the biological skin care solution we provide as the most complete and balanced natural product for all types of skin concerns.

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Scars are the final stage of the normal continuum of mammalian tissue repair. The ideal resolution would be total healing, with the new tissues having the same structural, aesthetic, and functional characteristics as the original uninjured skin. Scarless skin healing occurs in early mammalian embryos and complete regeneration occurs in smaller vertebrates, such as lizards, and some invertebrates (spineless creatures).

What, if any, are the advantages of scarring, and why do we scar?

A plausible hypothesis is that wound healing is evolutionarily optimized for speed of healing under septic conditions, where a multiple and redundant, compensating and rapid inflammatory response with overlapping cytokine and inflammatory cascades allows the skin to heal quickly to prevent infection and future wound breakdown. A scar may therefore be the price we pay for evolutionary survival after wounding.

Skin scarring: the clinical problem

Scars can be seen after almost every dermal damage-rare exceptions are tattoos, small scratches, and punctures of veins to take blood samples. Scars are frequently considered trivial, but they can be disfiguring and aesthetically undesirable and cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression, and disruption of normal tasks. Other psychosocial sequelae include appearance of posttraumatic stress signs, loss of self esteem, and stigmatization, resulting in diminished quality of life. Physical deformity resulting from skin scar contractures can be invalidating. Many scars take 2 to 3 years to pale and mature.

In spite of some suggestions to the contrary, scars cannot yet be made to disappear. Many people arrive at plastic surgery clinics with unfounded expectations. Clinical judgment is required when considering the right treatment, balancing the theoretical benefits of the various treatments available against the possibility of a poor improvement and possible infectious complications.

There is remarkable quantitative and qualitative variation in scarring potential between individuals and even within the same individual. Scars are normally worst in the deltoid and sternal regions and best in intraoral tissues, showing biological and mechanical differences between such sites. Injury in adolescents and young adults normally results in bigger scarring than does similar injury in elderly people, reflecting the altered inflammatory and cytokine profile of old wounds, which in many respects resemble those of the early embryo. People with pigmented skin are more prone to greater skin scarring than white people.

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Scarring can bring deep physical and psychological problems. To know the different kinds of scars is important to achieve an effective treatment.

Recent Research about Causes of Scars

Prevalence of scarring and keloids

Yang YC, Cheng YW, Lai CS, Chen W.
Department of Dermatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University, College of Medicine, Taiwan.

BACKGROUND: There have been few studies on childhood dermatoses performed by direct inspection of dermatologists.

OBJECTIVE: To investigate the prevalence of selective childhood dermatoses in Taiwan.

METHODS: In a cross-sectional study carried out in June 2004, 4067 of 7851 children aged between 6 and 11 years living in the Kaohsiung County in south Taiwan were clinically surveyed and examined by two board-certified dermatologists (response rate 52%), regarding the point prevalence of acne, ephelides, warts, atopic dermatitis (AD), psoriasis, alopecia areata (AA) and keloid.

RESULTS: Acne vulgaris was found in girls and boys from the age of 6 and 7, respectively, with comedones being the earliest presentation. Ephelides were not infrequently observed in our children (prevalence rate 8.4%, 95% confidence interval, CI 7.9-9.3%). The prevalence of warts on hands was 2.4% (95% CI 1.9-2.9%). The prevalence of AD was 1.7% (95% CI 1.3-2.1%), without gender difference. There were only four cases of AA but no psoriasis was found. Keloid was identified in 13 boys and 10 girls, accounting for 0.6% (95% CI 0.598-0.602%) of the children.

CONCLUSION: Acne vulgaris is as common in Taiwan as in Western countries. Ephelides are not uncommon in our population with the main skin types III-IV. A clustered distribution of the wart infection was noted. The low prevalence of AD in Taiwan seems unaltered over the past decade. AA and psoriasis are rare in our series. Most keloids in our children are caused by BCG vaccination.