9 July 2020
Dr. Federico Cipriani tells us what scars are, the different types there are and how to treat them.
Scarring is an extremely complex physiological process that takes place whenever a loss of substance in an organ or tissue occurs.
For didactic purposes, it is divided into 4 phases which follow each other and sometimes overlap —according to an interactive and still-not-well-defined space-time dynamics.
The first phase, called haemostatic phase, is characterised by the formation of a fibrin clot that allows the wound to close by creating a temporary matrix.
The second one is the inflammatory phase, during which the cells of the immune response move —through vasodilation and diapedesis— into the damaged tissue to get rid of any contaminants. In this phase, the wound is oedematous (swollen) and strongly hyperemic (reddened).
During the third phase, known as proliferative phase, endothelial cells take care of neoangiogenesis and form the granulation tissue in synergy with the epithelium, which migrates from the wound edges to restore the continuity of the injured tissue.
The last phase, called the maturation and remodelling phase, is the longest one and can last from 3 weeks to over a year. In this period of time, the scar evolves from an initial phase, when it is usually swollen and reddened, to a final phase in which it acquires a whitish colour and an inelastic consistency, without skin appendages with reduced blood supply and innervation.
However, scarring does not always follow a physiological pattern, case in which they turn sometimes into pathological scars. These are divided into two main categories:
- Atrophic scars
- Hypertrophic scars and keloids
Atrophic scars: The scar tissue that is being formed is not enough to cover the damaged area. This happens due to a lack of collagen, so the appearance of the scar in this case is depressed and indented, while often presenting a diastasis or hypopigmentation.
Hypertrophic scars: The scar tissue is produced in an abnormal way leading to the formation of thickened, inelastic, red, itchy and sometimes painful scars. Depending on the location, they can also cause functional as well as psychological limitations for the resulting aesthetic damage.
However, the scar tissue does not go beyond the limits of the wound but remains confined within its perimeter.
Keloids: Also in this case the scar tissue is produced in an abnormal and redundant way. Yet, unlike hypertrophic scars, keloids are characterised by a tumour-like behaviour, in the sense that they are not limited to the perimeter of the wound, but rather tend to invade the surrounding tissues. This means that they generate offshoots sometimes resembling the claws of a crab —from which they originally take their name—. This generally cause significant discomfort from an aesthetic and sometimes functional point of view.
How scars are treated:
Whenever healing begins, some precautions should be taken during the maturation phase to improve and promote the physiological healing process and prevent hypertrophy.
After the wound has healed, it is important to massage the scar applying moisturizer at least twice a day to soften the scar tissue and detach it from the surrounding tissues.
We then recommend applying silicone-gel ointments, or silicone patches, which prevent and reduce the onset of scar hypertrophy thanks to their mechanical function.
To avoid discolouration of the scar, using high-factor photo-protection before sun exposure is also essential.
For pathological scars, such as hypertrophic scars and keloids, the plastic surgeon can follow several different strategies, which can be divided into conservative or medical ones, on the one hand, and surgical solutions, on the other.
- Massage with moisturizing creams, repeated several times a day
- Continuous compression (whenever possible)
- Occlusion with silicone-gel sheets or silicone-gel ointment
- Intralesional corticosteroid injection
- Laser treatments
- Scar monitoring
- Intralesional excision
- Complete excision
Both medical and surgical therapies can be performed on an outpatient basis with immediate resumption of social and work activities.
FOR FURTHER INFORMATION PLEASE CONTACT:
☎️ (+39) 333 4346756
BOLOGNA (ITALY) 🏥
Studio Medico Cipriani
☎️ (+39) 051 220082
📍 Via Massimo D’Azeglio 68
FLORENCE (ITALY) ⚜️
Studi MediPro Firenze
☎️ (+39) 055 674584
📍 Via Aretina 167/M