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Types of scars

Depending on appearance and histological structure, scars are divided into normotrophic, atrophic, hypertrophic and keloids. The last to types refer to the group of pathological scars.

Fig.1. Abdominal normotrophic scars

Normotrophic scars are leveling with the surrounding skin are the most harmless by nature (scar removal techniques). They are formed as a result of an adequate reaction of the organism to the injury. Later they become thin, whitish and do not cause physical discomfort to the bearer. Such scars typically do not require correction, apart from the cases of aesthetical improvement of scar appearance or acceleration of colour normalization process.

Atrophic scars are below the skin level are often the result of injury or inflammation (scar reduction treatment). Atrophic scars are subdivided into the types as follows: ice pick scars (fig.2.A); boxcar scars (fig.2.B) and rolling scars (fig.2.C).

Fig.2. Types of atrophic scars

The skin above the atrophic scars is thin, loose and often with cross-striation. Such scars are usually devoid of pigment and therefore look white. The characteristic appearance of these scars is stipulated by connective tissue defect under beneath the scar, collagen and elastin deficiency – principal proteins forming the skin matrix.

Fig.3. Hypertrophic scar of achilles tendon area

Keloid or hypertrophic scars after piersing is the main reason to occur in the region of the ears. Hypertrophic scar, like keloids, overtop the surrounding skin, but do not lap over the damaged area. Collagen fibres acting as the scar substrate are wide and callous, but are located roughly on the parallel level with the skin surface. Hypertrophic scars are usually formed after surgical procedures and injuries of the flexible skin areas (of the joint area, for instance) resulting from serious inflammation, consecutive infection, decrease of local immunity, endocrine dysfunction, to mention a few (removal keloid and hypertrophic scar).

Fig.4. Post-burn keloid scars

Keloid scars or keloids exceed the size of initial wound significantly. Massive proliferation of connective tissue in the areas of burns, wounds, post-acne (so called acne keloid scars) and post-surgery injuries is observed. Collagen fibres are located chaotically and node-like, resembling a fingerprint. Despite their prescription, keloids can be active (growing) and inactive (stabilized). An active scar develops and causes pain, itching, numbness, emotional distress, and looks like a strained red scar, often with a bluish tint. Inactive keloid is not developing and does not bother the bearer from the subjective perspective, has a pink colouring or the one close to the colour of normal skin. Keloids are typically localized in the regions of ear lobe, decollate, shoulders and back (removal keloid and hypertrophic scar)
It is possible to predict the type of the future scar based on the mechanism and nature of the injury, localization area, depth of effect at the scarring stage: normo-, hypertrophic scar or keloid. This, however, is within the scope of the professional, because only the professional can influence the formation of a certain scar. Therefore, all scars must be supervised and attended to by the professional.
The sooner a patient consults the doctor, the earlier and more efficient treatment and correction will be.