Scar (Keloids)

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Scar
Body Parts: Whole Body
Medical Subjects: Skin
Overview

What Is Scar

What is a scar?

Scar, commonly known as scar or scar, is a general term for the appearance of skin tissue or the pathological changes of tissue itself caused by skin injury.。

In popular parlance, the human skin can be compared to a wall, which is composed of different structures from outside to inside. Very superficial phenomenon of scraping paint, the body through the original factory original cell regeneration supplement, can achieve complete repair effect; However, if the injury was deeper, the non-renewable tissues such as hair follicle sweat glands would be damaged, and then the damaged tissues would be repaired by scar tissue.

There are rational and pathological differences in cicatrix. Physiological scars are generally invisible to the naked eye and do not require treatment; However, pathological scars can cause great psychological or physical pain and difficulty in moving to patients from the aspects of appearance or body function, and can be treated by drugs, surgery, laser and other methods.

Is scar and keloid the same kind of disease?

There are two types of scars, i.e., biological and pathological scars. Pathological scars include hypertrophic scars and keloids. It can be seen that cicatrix and keloid are not exactly the same thing; cicatrix is a broader term.

How are scars classified?

  • Physiological scar: The patient had no obvious discomfort and did not affect the aesthetics. There was no dysfunction in the cicatrix (for example, did not affect the movement and contraction). Physiological scars do not require treatment.

  • Pathological scar: Patients have discomfort that affects aesthetics, and cicatrix sites have dysfunction that requires treatment.

  • Hypertrophic scar: Refers to scars that are confined to the initial area of injury and often spontaneously resolve over time.

  • Keloids: Refers to the scar that extends beyond the initial area of injury and invades the surrounding normal skin, often resembling a crab claw.
    In addition, pathological scars can also be divided into immature scars and mature scars according to the stage of scar development.

  • Immature scar: It refers to the early stage of wound healing. The local scar is red in color, and the dilated capillaries are visible on the surface. The surface is relatively rough, with relatively hard texture and poor elasticity. It may cause pruritus, pain and other discomfort.

  • Mature scar: Growth is slow, generally need 1 year or so, long can reach a few years, its color is similar to the skin around, the surface does not see dilate capillary, texture becomes soft, unwell symptom disappears.

The remaining classifications will not be described in detail for the time being.

Are scars common?

Physiological scars are very common and present in almost everyone.

Pathological scars are disease states, and the statistics of their morbidity are available in some regions. For example, the annual incidence of pathological scars is reported at 15 per 10,000 people in the Taiwan Province area.

Men and women have the same risk of pathological scars, which are more common in young people.

Cause

What Is The Cause Of Scar

What are the common causes of scars?

Scars are often caused by superficial injuries, such as abrasions, burns, electric injuries, and knife cuts. The state around the wound after injury also affects cicatrix formation, such as wound infection and foreign body retention.

Who are the most common people with scars?

Again, physiological scars are a normal process of repair after skin injury that can occur to anyone.

Pathological scar is a disease state. Current research shows that the deeper the skin color, the heavier the scar, that is, the African scar will be heavier than Asian, Caucasian lighter. Moreover, it is also related to constitution. People with scar constitution are easily to cause keloids after trauma.

Scar can heredity?

Keloids in pathological scars have a certain inheritance. Colloquially, if a person has a history of keloids, then their relatives are also susceptible to keloids after injury.

Symptom

What Symptom Does Scar Have

What are the common symptoms and manifestations of scars?

  • Early scarring: The scar tissue is red and thick (higher than the peripheral skin), and the local pain and itching are obvious, and different degrees of contraction may occur (i.e., the affected part's skin is tight and painful, mainly due to tissue contraction and deformation).

  • Scar stable stage: Months to years after the injury. The local pain and itching symptoms were significantly alleviated or disappeared, and the scar locally softened and narrowed, with the color changed from red to dark brown. Accord to different types of scar, each has subtle differences:

  • Superficial scar: The injury level is relatively shallow (it can be imagined as near the junction of the wall skin and the brick), and it is generally found in mild abrasions and superficial II burn (the burn is divided into three degrees: I painful, without foaming, and it is the mildest; Shallow II painful, foaming; Deep ii blisters but less pain). The surface of the scar is rough and sometimes darker (medically pigmented) and locally soft.

  • Atrophic scar: The injury layer was deeper than that of superficial scar (partial damage of wall bricks could be imagined), and it was more common in large-area III° burn, long-term chronic ulcer healing (such as bedsore), and injuries in relatively few parts of subcutaneous tissue (such as scalp and anterior crus region after electric injury). Scar is hard, and muscle or nerve adhesion is tight, so will pull muscle to make it unable to normal activity, poor local blood circulation, pale red or dark color, thin and easy to damage the epidermis. Repeated breakage for a long time may lead to malignant transformation.

  • Hypertrophic scar: It was obviously higher than that of normal skin, with a thick surface. In the early stage, the surface was dark red, wet, and itchy and painful. In the later stage, the discomfort gradually disappeared. It is more common in blood-rich areas, such as the face and neck. It is stuck to deep tissues and can be pushed (that is, when the macula is massaged, it is felt that the scar on the skin is a large mass, but it can be pushed). It will also contract, but if it grows in the non-joint area (knee joint, elbow joint) it will not affect movement, and if it grows in the joint, it will cause difficult joint movement due to pulling of the nearby tissue in the late stage.

  • Keloids: Also known as crab foot swelling in medicine, it has a high incidence in special populations (commonly known as scar/scar constitution) and may be inherited. Burns, trauma, even minor injuries, infections, localized skin inflammation, foreign bodies, and so on, can be caused. It is more common in head, neck, shoulder, chest and back, and less common in eyelid and palm. Its greatest feature is that it will continue to grow! That is, they continue to grow for weeks or even months after the injury and generally do not contract. There will be no maturation and subsequent degradation. But it rarely goes bad.

 

What other diseases can pathological scars in scars cause?

Different scar can present different complications, such as:

  • Atrophic scar: There will be repeated breakage, infection, and even malignant transformation.

  • Hypertrophic scar: If it grows in the joint area, it will seriously affect the joint movement.

Detect

How To Check Whether To Have Scar

How is scar diagnosed?

The pathological scar can be diagnosed as the abnormal bulge visible to the naked eye formed after trauma, accompanied by the pain and itching of the skin, local atrophy and deformation. Doctors segment them according to their degree. No special examination is generally required. However, when local malignant transformation or other conditions are suspected, the doctor will take part of the tissue for pathological examination (it is also possible to take the sections for submission during surgical resection).

For cicatrix, there are some internationally recognized evaluation methods, such as Vancouver cicatrix scale (VSS), which are widely used in the evaluation of hypertrophic cicatrix after burns in foreign countries and Hong Kong. POSAS is also a tool for scar assessment.

Prevention

How To Prevent Scar

Can scar be prevented? How does scar prevent?

Prevention may even be more important than treatment for scars!

Scar prevention should be carried out from the early stage of injury and the immature stage of scar. According to the recommendations of the scar prevention and treatment steering group composed of foreign Mustoe and other experts:

  • Preventive treatment strategies were used for immature hypertrophic scars (red in color and slightly convex). If the erythema persists for more than one month, it is treated as hypertrophic scar.

  • For linear hypertrophic scars (with red color, bulge and itching), the silicon gel membrane is firstly recommended to be used, which fails after lasting for more than one month. In addition, intradermal injection of glucocorticoid is used, and the above treatment still fails after 6–12 months. Surgical treatment is considered, and the silicon gel membrane is used after the operation.

  • Silicon gel membrane combined with intradermal glucocorticoid treatment was preferred for small keloids. If no significant effect was observed, surgery combined with radiotherapy was performed and the above therapy was continued after surgery. There is currently no effective treatment for large keloids.

  • The treatment of extensive hypertrophic scars begins with a combination of silicon gel membrane and pressure therapy. Professional pressure clothing can be customized and the treatment lasts for not less than six months.

How does scar/scar constitution person prevent keloid?

If some relatives have keloids, or he had a history of keloids, that he may be a scar constitution, should pay attention to prevent at ordinary times:

  • Try not to wear ear holes or holes in other parts of the body;

  • If it is for aesthetic reasons only and not for therapeutic purposes, nevus removal should be avoided as far as possible;

  • Treat acne or wound timely.

  • If injury or scarring occurs inadvertently, to keep the wound moist while it is healing, apply a thin layer of Vaseline to the wound and cover it with a bandage or gauze.

Treatment

How To Treat Scar

Pathological scar wants to see which branch?

You can visit dermatology department and cosmetic plastic department.

Scar can oneself good?

  • If it is normal physiological scar in human body, no special treatment is required, and it is the normal repair function of human body.

  • If it is a pathological scar, especially affecting the aesthetics and limb movement, it is difficult for the patient to recover from it, and medical treatment is required.

How is scar treated?

Pressurization and medication:

  • Topical drugs: such as asiaticoside cream, Kang Ruibao, etc.

  • Oral medication: Various vitamins can be used to prevent and treat scars, such as vitamin A, vitamin E, and 1-25 dihydroxyvitamin D3.

  • Silicon gel therapy: Silicone drugs can obviously improve the appearance and texture of scars and reduce local itching sensation, such as scar enemy, scar iron and scar equality. The common adverse reactions were dry local skin and rash.

  • Pressurization: Local application of elastic sleeves or elastic bandages can be used to prevent and treat hypertrophic scars, as well as burn scars and large-area scars across the body. Cicatrix in body depression has poor application effect. It is not recommended for children in growth phase to avoid bone deformity. The key to its treatment is to implement it as early as possible and start it before scars are formed after wound healing. Apply the appropriate pressure locally, rather than just the better. Keep for long enough time: It is generally recommended to apply continuous compression for 24 hours, lasting for more than one year. Here we have to mention selina, a severely burned member of the SHE, who had been wearing pressure clothing to treat postburn scars for a long time after his injury.

Drug injection therapy:

  • Hormone therapy: Diprospan and triamcinolone can be used to treat hypertrophic scars and keloids.

  • Chemotherapy drugs: fluorouracil, pingyangmycin, and colchicine are locally injected into the scars and are generally used to treat hypertrophic scars and keloids and sometimes they can be used together with hormonal drugs. These drugs are strictly prohibited for children.

  • Other drugs: such as recombinant interferon, hyaluronidase, antihistamines.

Laser therapy

  • Such as pulse dye laser, lattice laser, photodynamic therapy, etc.
  • Foreign doctor Manuskuatti said that the 0.45ms pulsed dye laser could shrink and soften the scars, making it suitable for burns and post-traumatic scars. Doctor Tan Jun of China said in his paper that CO2 laser is very suitable for the treatment of superficial scars with uneven surface or uneven pigment.
  • Different cicatrices are suitable for different treatments. Please accept the advice from a regular hospital and be careful not to listen to the so-called folk prescription or foreign imported instruments from an unqualified beauty studio or beauty salon on the street.

Cryotherapy:

  • Such as liquid nitrogen. It is suitable for small area cicatrix, but it has adverse reactions such as difficult to control the freezing depth, easy to form frostbite blisters, delayed wound healing, skin atrophy, pigmentation, etc., and it is rarely used now.
  • The current modified method is to apply cryoprobe for intradermal cryotherapy.

Radiation therapy:

  • The X-ray was first used by Debeurman and Gongerot in 1906 to treat scars, but it was rarely used due to the difficulty in mastering the ray energy and the depth of tissue effect.
  • β -ray isotope applicators such as 32P, 90Sr-Y are commonly used at present.
  • Radiation therapy is strictly prohibited for children.

Surgical treatment:

  • The purpose of surgical treatment is to reduce the scope of the scar, and it is suitable for severe hypertrophic scars, especially for patients with difficulty in movement caused by the atrophy and traction of the limbs joints due to the scar.
  • Premature surgery is not recommended for patients without severe mobility difficulties because of the prolonged maturation of scars, which is usually greater than 1 year.

Do scars need hospitalization?

Depending on the type of scar, mild pathologic hypertrophic scars can be treated as an outpatient, and severe patients require inpatient surgery.

What are the common risks of surgical treatment of scars?

Postoperative flap necrosis and poor wound growth may occur, followed by cicatrix recurrence.

How long does cicatrix operation want to restore after treatment?

According to the type and size of scar and different postoperative adjuvant treatment, the recovery period is also not identical.

Can pathological scar effect a radical cure?

Pathological scars have a certain possibility of recurrence. For example, glucocorticoid injection is used solely to treat scars with a recurrence rate as high as 50%. Therefore, in order to avoid recurrence to the greatest extent, doctors will give comprehensive treatment and require you to conduct frequent and regular re-examination. Fortunately, the earliest intervention can be given in time when there are signs of recurrence.

Life

What Should Scar Patient Notice In Life

What should scar patient notice on diet?

There is no special taboo on diet, and a healthy and balanced diet is enough.

  • Pay attention to less salt when cooking, less oil, less high salt seasoning, eat less pickled vegetables, meat, etc.;
  • Reasonable collocation of meat and vegetable, meat preferred chicken, duck, fish and other white meat, eat less fat, eggs, milk is an important source of protein and other nutrients;
  • If you are a vegetarian, you can eat more beans and soy products to supplement protein;
  • Eat more fruits and vegetables;
  • Try not to drink.

Can scar color because soy sauce wait for brunet food to become deep?

No.

What are the precautions after scar operation? How to care?

  • It has been reported in the literature that exposure to sunshine after surgery can worsen scars, so people should not be exposed to sunshine during the cicatrix healing stage. The scar should be covered within three months, and sunscreen can be applied to the scar.
  • Second, wound infection, foreign body and other stimulation easily cause recurrence, pay attention to the wound protection, to avoid infection.

Does scar treatment need reexamination after? How to reexamine after scar treatment?

Because cicatrix is a very long process, reexamination is helpful for doctors to formulate and adjust treatment plan according to the growth situation of cicatrix, and timely intervention is required for early detection of signs of recurrence. Therefore, reexamination must be conducted on time. Generally, the reexamination is conducted once a week in the early stage after surgery, and then the reexamination cycle can be extended as the condition stabilizes.

Can patients with scars travel by plane, do strenuous exercises and go to the plateau?

There are no definitive literature studies on the effect of air pressure on scars in the cicatrix growth phase. However, sweating and local skin friction caused by severe exercise may cause infection of the wound and deterioration of the scar, so severe exercise in the scar growth period is not recommended. In order to enhance the body constitution, a proper amount of exercise is enough.

How should cicatrix patient take care of?

Because cicatrix may cause patients with continuous pain, itching and other uncomfortable stimulation, local contracture will affect the beautiful, and its recovery period is long, so we must pay attention to the psychological intervention of patients, more communication with them, and actively give encouragement, let its attention, improve confidence, cooperate with the treatment.

In the middle of the disease can be on the scar joint or skin massage, promote joint rehabilitation, and urge its regular review on time.

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