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by Erin Looney, DPT

Scars can be both good and bad.  Scar tissue is good in that its formation is a crucial part of your body’s natural way of healing itself when the skin has been compromised.  However, scars can also be bad if excessive tissue restrictions develop.  These restrictions may lead to pain or problems with surrounding tissue.

When an injury to the skin occurs, the body responds by making a blood clot around the opening to close the wound. Once this has happened, fibroblasts, cells that regenerate new healthy tissue, flock to the area of injury.  These cells begin laying down collagen fibers to repair the area.  These same collagen fibers are also found in normal skin.  The difference between collagen in normal skin and collagen in scar tissue with the way the collagen fibers are arranged. Fibers in normal skin overlap in many random directions, allowing the skin to expand and move in many directions.  However, the collagen in scar tissue is arranged in more of a parallel fashion.  As you can imagine, this creates restrictions, changes the texture of the scar, and minimizes the skin’s extensibility.

A scar’s appears can be influenced by many factors – cause of the injury, skin color, presence or absence of infection, and the location of the scar. This new tissue will also lack sweat glands, hair, and have an abnormal blood supply. The following are 5 main types of scars:

Atrophic scars: These scars sink down into the skin (ex. acne scars).

Hypertrophic scars: These can be red or purple and are raised above the skin.  They tend to fade and flatten with time (ex. post-surgical scars).

Contracture scars: These pull the surrounding skin in toward the side of the injury (create a puckered look).

Keloid scars: These are very dark and raised and often grow bigger than the site of the oringinal injury.

Stretch marks: These do not happen as a result of an injury, but are caused by a rapid stretching of the skin (ex. pregnancy, rapid weight gain).

While there is no way to get rid of a scar there are ways to minimize the negative effects during the healing process.  While the wound is healing, you want to keep the wound covered when in the sun.  The UV rays will lead to further discoloration of the scar and may slow the healing process. Once the wound has completely closed you will want to get those new collagen fibers moving.  This will encourage early mobility and minimize the development of soft tissue restrictions.  Massage the scar in all directions.  This may be uncomfortable at first, but will improve with time.  If the healing tissue is kept moving, it will not have a chance to bind down to the layers below.  That new collagen will learn to stretch and move right from the beginning!

Massage — Massaging a scar with lotion or a doctor-recommended gel can help fade many types of scars. This is particularly recommended for keloid scars, since this can keep them from getting sensitive and painful, and can help break down some of the built-up collagen.

Injections — Steroid injections may help with hypertrophic or keloid scars, and atrophic scars can sometimes be filled in with collagen injections. One downside to this type of treatment is that it is almost always temporary, and has to be repeated regularly.

Skin resurfacing — This can be done with lasers or with equipment that works like very fine sandpaper in a procedure called dermabrasion.

Cryotherapy — This is a technique of freezing the scar, and can reduce the appearance of keloid and hypertrophic scars.

In extreme cases, a doctor might recommend surgery. Though surgery can’t get rid of a scar, it can make it less noticeable. Surgery is not recommended for hypertrophic or keloid scars though, since it can make them worse. Another type of treatment for severe scars is radiation therapy, which can sometimes reduce keloid and hypertrophic scars

Dr. Looney is a Physical Therapist at Boston Sports Medicine