Scarring and the Skin Healing Mechanisms

The removal or reduction of scars, lesions, and stretch marks from the skin depends on a process called "skin remodeling".

The skin is designed to heal wounds rapidly to prevent blood loss and infection. Scars are created from a rapidly formed "collagen glue" that the body brings into an injured area for protection and strength. In ideal skin healing, wounded skin is rapidly closed, and then the healed area is slowly repaired to remove the residual collagen scars and blend the skin area into nearby skin.

Scar collagen is removed and replaced with a mixture of skin cells and invisible collagen fibers. This remodeling may continue in a skin area for up to ten years.

In children, the remodeling rate is high and scars are often rapidly removed from injured skin areas. But as we reach adulthood, this rate slows down and small scars may remain for years.

One way to accelerate remodeling is to provoke a little amount of controlled skin damage with a needle, laser, acid, or other means, and then let the body repair processes rebuild the skin area.

A second method is to use enzymes and activators of skin renewal fibroblasts to increase the body's natural healing processes and achieve even better final results. Fibroblasts are the cells in the basal membrane of the skin and they are the precursors of all the structural elements of healthy skin, including those that provide moisture, tensile strength and elasticity to skin. Enzymes dissolve or "digest" damaged and dying cells.

Wound Healing

Scars are always needed to reconnect skin that has been injured. Initially, they may be red or dark and pink after the wound has healed but will become paler and flatter naturally over time, resulting in a flat, pale scar.

For reasons that are yet to be fully understood, some people form raised scars that are red and thick and may be itchy or painful. Others develop scars that extend beyond the site of a wound, called keloid scars.

Keloid scars are actually thick, itchy, puckered clusters of scar tissue that grow beyond the edges of an injury or incision and rarely regress. They occur when the body continues to produce tough, fibrous protein (known as collagen) after a wound has been repaired.

Keloid scars can result from any type of injury to the skin, including scratches, insect bites, tattoos, injections or medical procedures. Keloid scars can appear on any part of the body, but most commonly occur over the breastbone, on earlobes and on shoulders.

Keloids are fibrotic tumors characterized by a collection of atypical fibroblasts with excessive deposition of extracellular matrix components, especially collagen, fibronectin, elastin, and proteoglycans. Histologically, keloids contain relatively acellular centers and thick, abundant collagen bundles that form nodules in the deep dermal portion of the lesion. Keloids present a therapeutic challenge that must be addressed as these lesions can cause great pain, pruritus (itch) and physical disfigurement, may not improve its appearance over time, and can even affect mobility if located over a joint.

Hypertrophic scars use to be difficult to distinguish from keloid scars histologically and biochemically, but unlike keloids, hypertropic scars are confined to the wounded site and often mature and flatten out over time. Both types produce larger quantities of collagen than normal scars, but often the hypertrophic type shows declining collagen synthesis after about six months. Hypertrophic scars contain nearly twice as much glycosaminoglycans as normal scars, and this and enhanced synthetic and enzymatic activity result in important changes in the matrix which affects the mechanical properties of the scars, including decreased extensibility that makes them feel firm.

As with hypertrophic scarring, people who have developed one keloid scar are likely to be prone to this condition in the future and should alert their doctor or surgeon if they are going to need injections or to have any kind of surgery.

Atrophic scars use to cause a thinning and diminished elasticity of the skin because the loss of normal skin architecture. An example of an atrophic scar is striae distensae, also called stretch marks.

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