A scar is born

Posted on 9 March 2016

Scars are a part of life, and each one is a souvenir of your body’s adventures – but the science behind how scars form is a story all on its own. Dr Sian Hartshorne, a dermatologist in Plettenberg Bay, tells us more.

Pretty much everybody has one, and each one has a story. There’s the one you got when you fell off the swings at playschool, or the one you got when you crashed your bike, or the one you got from the surgery that saved your life. Scars are a natural part of your body’s healing process, and they’re the result of the biological process of wound repair. Most scars are found on your skin, but they can occur internally as well, on other tissue.

The skin
Your skin has three main layers: the epidermis (a thin outer layer); the dermis (the deep, thick layer below that); and subcutaneous tissue (below the dermis). Scars form when your dermis is damaged, as your body creates new tissue to fix the damage. Scar tissue is made of collagen – the same protein as the tissue it’s replacing – but the composition of the fibre is different. Instead of the random, crisscross fibres found in normal tissue, the collagen fibre in scar tissue grows in a single direction. It’s a real feat of engineering: almost as if your body is building a bridge from one side of the cut to the other.
Collagen scar tissue isn’t as strong as normal collagen, which is why the scars on your skin are less resistant to ultraviolet radiation, and why hairs and sweat glands don’t grow back on scarred skin.

Keloid scars and stretch marks

You’ll have noticed that not all scars look the same – and the collagen bridge-building is the reason for that. If your body produces too much collagen during the healing process, you’ll get a raised scar called a hypertrophic scar, or – if it grows beyond the area of your original wound – a keloid scar.

‘Certain areas of the body – such as the back, chest and shoulders – are more prone to developing keloid scars,’ says Dr Sian Hartshorne, a dermatologist at Mediclinic Plettenberg Bay. ‘Some people are also genetically more prone to developing keloid.’ Keloid scars can be treated with external beam radiotherapy or with certain steroids. ‘Keloid scars are difficult to treat, but cortisone injections into the scar, silicone-containing creams or external beam radiotherapy can improve the appearance of the scar and decrease it,’ adds Dr Hartshorne.

Stretch marks are another form of scarring: these happen when the dermis gets torn, usually through stretching caused by rapid growth or weight changes (they’re relatively common in women who’ve been pregnant).

To prevent wounds from leaving ugly scars, you need to minimise the amount of work your body has to do in the healing process. ‘Giving support to the wounds by using micropore plasters for two to six months can help prevent bad scars,’ says Dr Hartshorne. ‘You can also use creams or oils to massage the scar daily. Creams containing silicone help to improve healing. These creams can be applied over the micropore plaster twice daily.’
Avoid direct sunlight (which can cause discoloration), or use sunblock daily if a scar is on an exposed area of skin. Don’t use harsh chemicals like hydrogen peroxide: these can cause irritation and slow down the healing process.
‘The skin is a fascinating organ with incredible ability to heal,’ says Dr Hartshorne. ‘Even scars can, over years, slowly improve until they almost disappear and become forgotten.’
Remember, though, that healing takes time. Scars can take up to a year to form, and they can keep changing for months after that.

Stars and their scars
Harrison Ford

His chin scar didn’t come from Indiana Jones’s whip; he crashed his car into a telephone pole while trying (belatedly) to put on his seatbelt!

A rare skin disease called discoid lupus erythematosus left this Grammy-winning singer with scarred cheeks.

Franck Ribéry
A childhood car crash left the French soccer star with deep facial scarring.

Tina Fey
As a child, the Emmy-winning actress was attacked by a knife-wielding stranger, who left her with a long, thin scar on her face.

Sizwe DhLomo
The TV personality got his trademark facial scar while playing rugby indoors with friends.

Joaquin Phoenix
A microform cleft palate, developed in utero, gave the Hollywood star his trademark lip-to-nose scar.

Jonah Hill
After a car crash when he was a teenager, he woke in hospital to hear the doctors discussing whether or not to amputate his right arm. Luckily the movie star was left with only scars – and a lesson learnt.

DID YOU KNOW? Your scar’s location makes a difference. When it’s on places like the knee or shoulder, it’ll probably widen as these areas are in motion.

Published in Dermatology

In the interest of our patients, in accordance with SA law and our commitment to expertise, Mediclinic cannot subscribe to the practice of online diagnosis. Please consult a medical professional for specific medical advice. If you have any major concerns, please see your doctor for an assessment. If you have any cause for concern, your GP will be able to direct you to the appropriate specialists.

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One Response to “A scar is born”

  1. Molepo mahlatse says:

    I had an car accident and I have scars on my face I need help

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