The formation of a scar is a natural part of the healing process following an injury to the skin as the body repairs the wound.
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Factors affecting scar formation
The appearance of the scar after the area has healed depends on several factors including the type of injury, the area of the body affected, and the healing process itself.
Of these factors, the type of injury is a significant determining factor for the formation of a scar. Large incisions from surgical procedures or injuries from serious accidents, for example, are more likely to result in the formation of a scar as compared to minor cuts or scrapes to the skin.
Certain areas of the body, such as the skin over the knee and elbow joints, are also more likely to be affected by scarring.
Phases of wound healing
It is important to understand the wound healing process when considering how to prevent the formation of scars. There are six significant phases of wound healing, including:
- The hemostatic inflammatory phase involves the coagulation cascade, complement cascade, and platelet activation to stop the flow of blood out of the body.
- The cellular inflammatory phase involves an increase in the number of neutrophils in the area, which contribute to the phagocytosis of debris and bacteria to prevent infection. This is followed by an increase in macrophages, which secrete mediators to regulate the healing process. An increase in fibroblasts occurs several weeks after the injury, resulting in collagen secretion and closure of large wounds.
- The re-epithelialization proliferative phase involves remodeling the wound with the aid of enzymes and fibroblasts. The level of moisture in the area limits the rate of this phase.
- The neovascularization proliferative phase involves angiogenesis and the formation of granulation tissue.
- The collagen deposition proliferative phase involves the deposition of type III collagen.
- The maturation or remodeling phase involves the deposition of type I collagen, which leads to a reduction in the size of the scar and increased strength of the skin.
Transforming growth factor-beta (TGF-β) is a mediator of the hemostatic inflammatory phase that plays a significant role in wound healing and the development of scars.
The transition from an immature to a mature scar takes place approximately six months to one year after the injury.
Proper wound care: How to minimize a scar
Prevention of injury
The most effective way to prevent the formation of scars is to limit injury to the skin. To this end, some people may wish to limit participation in activities that carry a high risk of injury or to wear adequate protective gear.
For surgical procedures, there should be adequate planning for the size and type of incision, as well as how to close the area while minimizing skin tension.
Soft tissue handling techniques should also be employed in order to minimize skin trauma.
Promoting the healing process
There are four main areas that are recommended to promote the healing process and reduce scars, which include:
- Minimizing tension
- Maintaining moisture
- Avoiding inflammation
- Optimizing the molecular environment
There are several techniques that can aid in skin healing and help to prevent the formation of scars following surgery or an injury to the skin.
Firstly, it is important to keep the affected area clean throughout the healing process. This helps to reduce the risk of infection and to remove any debris in the wound, which can interrupt healing.
Dermatologists recommend washing the area gently with mild soap and water regularly for this purpose. If the area is cleaned on a daily basis, anti-bacterial ointments are usually not necessary.
Keeping the wound moist with petroleum jelly or a similar ointment can also help to prevent the area from drying out. This is an important aspect of the wound healing process, as it helps to reduce the depth and size of any scarring, as well as decrease the likelihood of scab formation, which can lengthen the healing process.
Once clean, the wound should then be covered with an adhesive bandage to promote healing in the area, as well as prevent further injury or the entry of bacteria. The bandage covering the wound should also be changed daily.
Massaging the area is often recommended to help minimize scar formation through the optimization of the molecular environment. This is usually recommended 10-14 days after the skin injury has originally occurred.
A massage, which involves the mechanical movement of the surrounding skin. leads to the expression of enzymes, which help to degrade fibrotic tissue and increase scar flexibility. In addition to these benefits, a massage is also useful in reducing pain associated with the injury due to the release of beta-endorphins.
Reducing the appearance of scars
After the healing process is complete and a scar has appeared, there are several things that can help to reduce the appearance of the scar on the skin.
For example, using adequate sun protection can reduce both hyperpigmentation and the time for the scar to fade. This may also help to prevent melanogenesis in the scar due to exposure to ultraviolet (UV) light. However, sunscreen will not reduce “rubor perseverance,” which is the reddening of a scar that is not linked to inflammation. Typically, this red appearance of scars will fade within a year of the injury.