Wounds and different type of scars

Skin tissues repair processcan result in a broad spectrum of scars, ranging from a "normal" thin line to a variety of abnormal scarring, including widespread scars, atrophic scars, scar contractures, hypertrophic scars, and keloid scars.

Widespread (stretched) scars can be seen when the fine lines of surgical scars gradually become stretched and widened, which usually happens in the three weeks after surgery. They are usually flat, pale, soft scars often seen after knee or shoulder surgery. Stretch marks (abdominal striae) after pregnancy are another type of widespread scars in which there has been injury to the dermis and subcutaneous tissues but the epidermis is unbreached. There is no rise, thickening, or nodularity in mature wide-spread scars, which makes them different from hypertrophic scars.

Atrophic scars are flat and depressed below the surrounding skin. They use to be small and often round with an indented or inverted centre, and often appear after acne breakoutsor chickenpox.

Scar contractures -scars across joints or skin creases at right angles are prone to develop shortening or contracture. Scar contractures occur when the scar is not completely matured, usually tend to be hypertrophic, and are typically disabling and dysfunctional (fig 4). They appear after burn injury across joints or skin concavities.

Raised skin scars

Raised skin scars are also known as hypertrophic or keloid scars.

Hypertrophic scars are raised scars left within the boundaries of the original lesion, usually disappearing by itself after the initial injury. Hypertrophic scars are typically red, inflamed, itchy, and sometimes painful. They use to appear after burn injury on the trunk and extremities.

Keloid scars are raised scars that spread beyond the margins of the original wound

Keloids scars are thick, puckered, itchy clusters of scars spreading beyond the edges of the wound or incision and invade the surrounding normal skin in a site-specific way. They use to be red or darker than the surrounding skin. Keloids appear when the body continues to produce collagen long after the initial lesion healing has taken place.

Ear lobe keloids often appear as large lobules, central sternal keloids commonly develop a butterfly shape, and deltoid keloids tend to grow vertically. A keloid continues to grow over time, does not disappear by itself, and almost invariably recurs after simple excision. It's difficult to use the term "keloid" until a scar has been present for at least a year, but there is no a fixed time interval. Histologically, keloids have a swirling nodular pattern of collagen fibres.

Scars that are difficult to categorise have been named intermediate scars. Yet, if a raised scar is still there after a year, a true keloid is a possible diagnosis, whereas hypertrophic scars should show some signs of regression within this time. Keloids can be inflamed, itchy, and painful, especially in their growth phase. Common presentations are in the ear lobe after ear piercing, the deltoid after vaccination, and the sternum after acne, chickenpox, trauma, or surgery. Keloids are exclusive to humans, and there may be some genetic predisposition, with dark skinned races being more prone to them, though there are few serious epidemiological studies. They appear predominantly in people aged 10 - 30 years, with an apparent predilection for emergence and deterioration during puberty and pregnancy.

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