What are the most common types of scars and what do they look like?

Various types of scars can form when the normal wound process is disrupted:

Scar formation is a natural part of the healing process that occurs when the skin repairs wounds caused by accident, surgery or disease. The time skin takes to heal will vary depending on the degree of damage, and the longer it takes to heal the greater the chance of a noticeable scar.

It is important to know, that scarring is considered to be the final stage of wound healing and all - partial thickness and full thickness wounds - will form scars, but not all of the scars will become abnormal scars. Normal scars will develop during the first 48 hours after wound closure and can fade within 3 months, whereas abnormal scars can occur up to 18 months later.

During the first phase of the scar formation (“inflammation”) there is little difference seen clinically between an abnormal and a normal scar. The body produces collagen fibers to close the wound and the affected area of the skin will appear red and thick.

This procedure continues in the second phase (“proliferation”), where the collagen fibers are secreted into granulation tissue and are arranged in a concentric or whirled pattern with the nodules growing and eventually becoming thickened and compacted bands lying parallel to the surface.

In the third and last phase (“maturation”), normally there is a balance between the formation of collagen and the destruction and removal of collagen. This balance is regulated by cytokines (or protein mediators) and other tissue inhibitors. Normally “type III collagen” is replaced by “type I collagen”, with closer cross-links resulting in increased wound strength. When this remodeling balance is disrupted, abnormal scar production occurs.

The risk of developing abnormal scars depends on your age, the location of your scar, genetic factors (such as skin type) and complications arising from exposure to wound infections:

Age

Keloids tend to develop most likely between the ages of 10 and 30 years. (Ref: 1,2,3) Also younger people are more frequently subjected to trauma.2

Skin healing is slow in older people, and their skin is less elastic, while younger skin tends to “overheal” forming larger, thicker scars.2

Genetic factors – skin type

People with darker pigmented skin, are prone to abnormal scars, particularly keloids.(Ref:1,2,3) Higher risks also appear to people with ginger hair and freckles and to those with previous pathological scarring4 or with a family history of such scarring.

Hormonal influences

Scars tend to develop larger during pregnancy and puberty. (Ref:1,2)

Scar location

Scars over or near muscles that are particularly active, such as the chest, back, legs, shoulders (e.g. deltoid muscles) and joints, often spread or become more visible than scars formed on less active areas.2 Earlobes, shoulders and pre-sternal skin have a high predilection of developing keloids. (Ref:2)

Wound infection or complications

Wound infection increases the likelihood of abnormal scarring. Some surgical procedures have an increased risk of scarring (e.g. breast surgery etc.) (Ref:4)