A scar is a more or less deep lesion of the dermis whose size, color, thickness and depth can vary. Types, treatments to be applied immediately: learn all about scars with Dr Éléonore Cohen, plastic surgeon.
What is the definition of a scar?
The scar is the visible part of a lesion in the dermis of the skin : she is the result of tissue repair after skin trauma, such as injury, surgery or disease (acne…). As Dr Éléonore Cohen explains “all scars need our body’s natural inflammation to heal. At the level of the wound, different cells are activated to recreate a bridge of skin between the two edges: this new skin is called the scar. She is devoid of hair, sweat gland and is insensitive. Its evolution is unique to each person. The scar can be of various colors and appearances : whitish, flat, sunken, puffy, reddish. It can fade over time or remain clearly visible depending on the case. Note that the scars can sometimes become infected and that the speed of healing differs from person to person.”
Why is a scar red?
It is usually the first phase of healing “this phase lasts about 3 months where all the scars are red, hard, raised, and itchy especially in the evening“explains the specialist.
Why is a scar white?
Most often, the scars then turn white and puffy, then fade over time. “Spontaneously in 2 to 4 years all scars improvewhiten, refine, flatten and soften“says the specialist.
What is a depressed scar?
A scar is said to be depressed when it is hollow and no longer in relief. Usually caused by acne or chickenpox, they can be red in color and difficult to fade.
What is a stretched scar?
Stretched scars appear when the skin around a wound is stretched. Stretch marks for example are stretched scars.
What is a hypertrophic scar?
THE hypertrophic scars are thick. “Some people have hypersensitivity and therefore an inflammatory reaction intense which give red, thick hypertrophic scars sometimes painful and adherent to the deep plane“ explains Dr. Cohen. They can also form when the skin is exposed to foreign bodies during the healing phase.
What is a keloid scar?
“Sometimes without knowing the real reason some people develop a scar tissue disease called Keloids, explains the specialist. Those are bulky and deforming scars“. This type of scar affects more often: the young subject, black or Asian skin, the ears, the lower part of the face, the thorax. “For example, we often see the keloid of the ear arriving in consultation after a piercing. adds Dr. Cohen. They can also appear after an injury, burn or surgery.
What delays wound healing?
Factors slowing scar healing include:
- Immunodeficiency causes, among other symptoms, a slowing of wound healing.
- Age: The healing process decreases with age. Young people heal better and faster than older people.
- Diabetes and skin vascular problems : High blood sugar levels can lead to poor blood circulation and slow healing.
- The quality of the suture.
- I’inflammatory hypersensitivity which prolongs the “hot” phase of normal healing (beyond 3 months).
- The presence of a foreign body in the wound.
- THE stress : two hormones released by the body in times of stress (adrenaline and cortisol) are responsible for slowing the healing of wounds.
- THE vitamin C deficiencies (which participates in the synthesis of collagen) and zinc (which participates in the synthesis of keratin) can also cause delayed healing.
What treatments to remove a scar?
The scarring of the skin “requires a humid environment and it is therefore essential to respect the dressing instructions and of do not leave to dry and crust in the open air” remind her French Society of Dermatology. It is also important to protect the skin from sun exposure by putting on an SPF50 protective cream. The scars are often unsightly, but it is important to keep in mind that the many treatments that exist can never completely make them disappear: they can however attenuate them, smooth them out or improve their appearance. Among them, the dermorestoration is a technique of dermal stimulation : using a cylinder composed of microneedles, this operation consists of activate collagen synthesis. This technique is used to treat acne or age-related scars. It also has dermabrasion which, thanks to a rotating device resembling a small grinding wheel, “punches” the skin to smooth and restructure it. The dermabrasion technique is used on protruding scars. Depending on the relief of the scar, 2 to 3 sessions may be sufficient. A small crust then forms, then disappears.
What creams to put on a scar?
Some creams can be effective in fading scars, if they are applied during the healing phase.
► For example in pharmacies: creams called “Cica”: Cicalfate®, Cicavit®, Bariéderm-Cica®,
► Any restorative cream zinc-based is effective: “Zinc calms the inflammatory phenomena of healing and participates in the synthesis of keratin” explains the specialist
► The topical corticosteroids improve scars that remain inflamed beyond 4 months.
► “A total sun protection for one year is essential to avoid the browning of the scar” explains the specialist.
What is the interest of pressotherapy in case of scar?
Pressotherapy is a method that consists of flatten a scar by compressing it. “Today is a very effective method to reduce scars, explains Dr. Cohen. One can practice a strong massage of the scars (discontinuous pressotherapy), or even offer the patient continuous pressotherapy by the weight of silicone gel or even silicone plates which press permanently on the scar and refine it.“
What is the effect of peeling on a scar?
The trichloroacetic acid peel is a deep peel, which requires local anesthesia. This chemical peel causes a significant peeling of the skin which will then allow its regeneration and theattenuation of scars. reactions like a
Edema, hives or scabs may occur as a result of this peel.
What are collagen injections used for?
The doctor injects collagen directly into the scar, using a needle. This treatment requires 2 to 3 sessions spaced 2 to 3 months apart. Please note that this treatment may cause allergic reactions in some patients.
What are steroid injections used for?
Steroid injections correspond to the basic keloid scar treatment. The product is injected directly into the scar to stop the multiplication of fibroblasts and the synthesis of collagen. The treatment thus makes it possible to flatten and soften the scar. To be repeated every 4 or 6 weeks.
Can surgery be done to remove a scar?
The surgical operation consists of removing the old scar and replacing it with another scar whose evolution will be monitored.
The laser or “resurfacing” makes it possible to correct defects in coloring and texture of the scar and will work on the quality of the surface of the skin. He not suitable for inflamed keloid or hypertrophic type scars. “The laser also makes it possible to control inflammatory phenomena. It can be applied preoperatively or after 4 months of the intervention.“adds the specialist.
Thanks to Dr Éléonore Cohen, plastic surgeon in Paris. Statements collected in 2020.