Scar is the collective name of the appearance and histopathological changes of normal skin tissue caused by various traumas, and it is the inevitable product of human trauma repair process. When the growth of scar exceeds a certain limit, various complications will occur, such as destruction of appearance and functional activity impairment, which bring great physical and mental pain to patients, especially the scar left after burns, scalds and severe trauma. At present, common keloid scars can be divided into 4 categories: superficial keloid scars, hyperplastic keloid scars, atrophic keloid scars and keloid scars.
Superficial keloid scars
Characteristics: Involving superficial layers of epidermis and dermis
Superficial keloid scars are formed by mild abrasions, superficial burns, or superficial skin infections, usually involving the epidermis or superficial dermis. Clinical manifestations are slightly different from normal skin in appearance, with rough surface or pigmentation changes and local flatness and softness.
Response: Most can heal on their own
There is usually no functional impairment, and the scar will gradually become less visible over time. Fractional laser intervention can be used if the fading is slow.
Hyperplastic keloid scars
Characteristics: Burning and itching sensation
Proliferative keloid scars develop after the skin injury heals and the scar continues to proliferate. Proliferative keloid scars are protruding from the skin surface, irregular in shape, uneven in height, flushed and congested, and firm in texture. There is a burning and itching sensation, and the symptoms are aggravated when the ambient temperature increases, when there is emotional stress, or when spicy and irritating food is eaten. The hyperplasia often continues for several months or years before gradually undergoing degenerative changes, manifesting as a decrease in the height of the protrusion, a darkening of the color, a decreasing of the congestion, and a softening. The length of this proliferative period varies depending on the person and the site of the lesion.
Response: Laser, needle-free autoclave repair
Some hyperplastic keloids can eventually be repaired with treatment and the pain and itchiness greatly reduced or disappeared, while others cannot be helped. For example, needle-free high-pressure gun + fractional laser treatment is very effective.
Atrophic scar
Characteristics: Hard scar, intolerant to friction, easy to break down
Occurs in patients with large burns, after healing of long-term chronic ulcers, and after injury to areas with less subcutaneous tissue such as the scalp and anterior tibial area. The injury is usually severe, involving the entire skin and subcutaneous fatty tissue. The scar is hard, flat or slightly above the skin surface, and is tightly adherent to deeper tissues such as muscles, tendons, and nerves. The scar has very poor local blood circulation and is light red or white in color. The epidermis is extremely thin and cannot withstand external friction and weight-bearing, and can easily break down and form a chronic ulcer that does not heal.
Response: Timely medical treatment is needed
For patients who repeatedly break down, there is a possibility of malignant transformation in the late stage, and the pathology is mostly squamous epithelial carcinoma. Atrophic scar has great contractility and can pull the adjacent tissues and organs and cause serious dysfunction. Therefore, timely medical treatment is needed. Early treatment can be performed with needle-free autoclave.
Keloids
Characteristics: Red-colored and hard lumps
Keloid is a result of excessive proliferation of collagen fibers, also known as connective tissue hyperplasia, or in Chinese medicine as crabfoot swelling or giant scarring, which is a benign lump of varying shape, red color and hard texture that bulges out of normal skin during the healing process of skin injury.
Response: Surgery + local radiotherapy to improve the appearance
The corresponding treatment modalities are different for different scars, some do not require treatment, while others can be treated by surgery, radiotherapy, injectable drugs, etc. All of these require a personalized treatment plan after diagnosis by a professional doctor.