Scarring / Skin Injuries

Skin Injury always results in fibrotic, non-functional scars in adults. A hundred million individuals worldwide each year acquire scars on their skin due to surgery or trauma, with 15% of these eventually progressing into hypertrophic scars or keloids. Updated scar management practical guidelines: non-invasive and invasive measures – PubMed. Scars with a large surface area not only affect the aesthetics but are also accompanied by pain, itching, sclerosis and scar contracture. Scars can also cause significant physiological distress, including higher rates of anxiety, depression and low self-esteem in individuals. Biopsychosocial impact of keloids on quality of life – PubMed    

Scars can be categorised in four distinct types: mature scars, immature scars, hypertrophic scars and keloids International clinical recommendations on scar management – PubMed. Mature scars exhibit a flat appearance and share the same resemblance as healthy tissue, while immature scars manifest during the tissue repair phase of wound healing with redness and swelling with a slight bulge at the injury site. With time, these immature scars can either progress into normal mature scars or develop into hypertrophic scars or keloids. Hypertrophic scars are categorised by a bulging appearance accompanied by persisting redness and swelling. When a scar extends beyond the original wound location and continues to enlarge, it is called a keloid.

Keloid Scars are widely considered one of the most challenging and severe forms of scarring. Their formation is due to a disorganised and fibroproliferative collagen response. Keloids: a review of therapeutic management – PubMed. There are a number of risk factors influencing natural healing.

These include:

• There is a familial aggregation with an increased prevalence in dark-skinned individuals of African, Asian and Hispanic populations compared to Caucasians. Certain genes have been linked to the increased risk of developing keloid scars Genetics of Keloid Scarring – Textbook on Scar Management – NCBI Bookshelf
• Most keloid scars are found between the ages of 11 and 30 with a peak incidence during puberty and early childhood. They can occur at any age but are rare in the extremes of life (young children and old adults) Keloid – StatPearls – NCBI Bookshelf. This is thought to be due to the skin being more active, having a higher collagen production and experiencing greater tension during the healing process.
• Females have a higher risk for the development of keloid scars. This increased risk if thought to be driven by physiological factors, particularly the role of hormones like oestrogen in wound inflammation and collagen production. Genetics of Keloid Scarring – Textbook on Scar Management – NCBI Bookshelf
• Locations. Keloids are more likely to develop in the scapular area, the shoulder and the anterior chest. These regions are subjected to constant or frequent skin stretching due to body movements. The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation – PubMed.