Too much collagen creates a raised scar
While a lack of collagen makes an indented one
Remember that time you cut yourself?
Or that spot you squeezed that caused a tiny scar on your face?
Or maybe you knicked yourself while shaving and now have an unsightly reminder.
But whether caused by a cut, burn, acne or injury, and yes, that includes picking your skin.
The scar remains long after your skin heals and that redness goes away.
As a skincare specialist, I am often asked whether it is possible to fade or diminish scars.
So for this article, we want to take a deep dive into the science of scars.
Together will look at what causes them, the types of scars and how they are formed.
So you’ll know how to treat those pesky little reminders once and for all.
Why we Scar
Several factors can have an impact on why your skin scars.
Genetics: Some genetic variations are associated with scar formation.
Darker Skin Type: You may be more prone to scarring if you have a darker skin tone.
Systemic inflammation: This can increase the risk of developing hypertrophic scars or keloids.
Skin diseases: Some diseases like epidermolysis bullosa can make the skin fragile, causing blisters that form a scar upon healing. The condition of hidradenitis suppurativa is another condition that can cause deep wounds in the skin.
Age: Skin loses collagen and elasticity with age, which can cause your skin to heal slower.
Injury: Scarring is more likely if you injure your skin or if it is in an area of skin that takes longer to heal, such as your knee or elbow.
Hormones: Your hormone levels can affect your body’s likelihood of scarring, and hormones can cause melasma or chloasma, which can lead to hyperpigmented scars.
But wait, don’t panic. All is not lost because the good news is that the extent to which your skin scars can largely, although not entirely, be controlled by how you treat them.
What is Scar Tissue
Scar tissue is not the same as skin tissue.
In scar tissue formation, the collagen proteins grow in one direction rather than in a multidirectional pattern, as they would if your skin was healthy.
When you have scar tissue, there is less elasticity, which is why it feels tight, and there may be limited movement and sometimes pain in the area.
Why is my Scar Tissue Painful?
If you are experiencing scar tissue pain, it may be caused by nerve damage from an injury.
Pain can also result from fibroblasts causing prolonged inflammation with itching, swelling, tenderness, and sensitivity symptoms. This condition is referred to as fibrosis.
It is not uncommon for scars to become painful later due to nerve endings regenerating over time.
How Does Your Skin Scar?
You will have to bear with us here as we get skin sciency.
The highly complex reparation process of your skin and how it scars is very organised, and this can be categorised into four main phases:
Let’s look at each of these in more detail, so you can begin to understand how your skin scars.
1. Hemostasis Phase
The hemostasis stage of wound healing occurs very quickly and is the process where your wound is closed by blood clotting.
It begins when the blood leaks out of your body, and the blood vessels constrict to restrict the blood flow.
The platelets stick together to seal the break in the wall of the blood vessels, and then coagulation reinforces the plugs with tiny fibrin threads, almost like a binding agent.
2. The Inflammation Phase
When you first injure your skin, it is in the inflammation phase, when your skin goes into immediate healing and begins to close up.
White blood cells, growth factors, nutrients and enzymes come to the site of the injury to help repair your skin, and this causes the swelling.
Jeez, isn’t our skin just a wonderfully complex thing?
The inflammation helps control bleeding and prevents infection; the fluid also allows your cells to move to the injury site and begin the awesome healing process.
If you’ve cut your skin and are worried about the inflammation, don’t be. It’s a natural part of your wound-healing process and is nothing to worry about; it only becomes problematic if it is prolonged or excessive.
3. The Proliferation Phase
This phase of your wound healing is when it is rebuilt with new tissue, which is made up of collagen and an extracellular matrix.
- First, a blood clot forms on your skin’s surface and covers the damage
- next, your wound scabs over, which protects your skin while it is healing
- than the wound contracts as new tissue is formed. And eventually, the scab falls off
In this stage, tiny fibroblasts (the cells that make new collagen) are sent out to start rebuilding new tissue.
Your body naturally produces collagen to reconnect tissues broken apart by injury, which is precisely how your scars are formed.
Scars comprise this firm, flexible collagen tissue formed during the repair process.
4. The Maturation Phase
Referred to as the remodelling phase of wound healing, this is when collagen is remodelled from type III to type I, and the wound begins to close up.
The cells used to repair the wound are no longer needed and are removed by a process known as apoptosis or an even more scary term called “programmed cell death” aahhh.
During the proliferative phase, when the collagen is formed, it is disorganised, which can thicken the wound.
After you injure your skin, the messy collagen is replaced with neater and more uniform tissue. This remodelling begins around 21 days after the injury occurs and can continue for a year or even longer.
In the final phase of this proliferative stage of wound healing, epithelial cells in your skin help resurface the injury.
An interesting fact is that epithelialisation happens faster if you keep your injury hydrated and moist; this is why we love to use Nectar balm, which contains healing herbs and anti-bacterial and antiseptic manuka and works like a mini band-aid.
To reduce and prevent scarring, try to apply the balm or an occlusive dressing within 48 hours of injuring yourself; this will help maintain the correct tissue humidity to optimise epithelialisation, which will help your skin’s cells to heal quicker and in a more orderly form.
The Different Types of Scarring
There are various scar formation patterns; they can be flat, raised or overgrown.
Active scars are often red, firm, thick, or raised and can feel sensitive and sometimes even limit motion and function; the primary types of scars include:
This is normal scarring; your scar is flat and is often itchy and painful, and it might be pink or red.
Ensuring you quickly and correctly treat your wound can improve the chances of your scar becoming flat rather than raised.
This type of flat scar will look most like your normal skin; it may be either lighter-hypopigmented or darker-hyperpigmented in appearance.
Contracture Scars (Scar tightening):
They are the scars you get if you have a severe burn.
Contracture scars are usually located over your joints; they form when the scar tissue is tighter and thicker than your surrounding skin and usually results from a large area of your skin being lost.
When scarring involves the muscles and nerves over a joint, contractures can make it difficult to move and cause pain.
This type of scar forms when the scar tissue is tighter and thicker than the surrounding area of your skin and usually results from losing a large area of your skin.
A hypertrophic scar is usually raised or “riding high” above your skin and is thick; it will remain within the original wound margin at the injury.
As this scar matures, it becomes more expansive and slightly elevated with a rope-like appearance; it can take up to two years for it to fully develop,
This type of scar is most frequently formed from wounds sustained on your chest, upper back, or shoulder area, although they can appear anywhere on your body.
Linear hypertrophic scars develop within weeks of surgery and may increase rapidly in size, but usually, around three to six months, you should see a size reduction.
These scars are raised and also “ride high” above the surface of your skin and extend beyond the original wound margin at the injury; they are usually red and form on your skin after an injury.
If you have a large raised keloid scar, it may be painful and grow more significant than the wound that initially caused the scar.
When the dermis layer of your skin kicks into an aggressive healing mode, it sends the fibroblasts to distribute collagen to help rebuild new tissue.
But instead of having the time to lay everything out in an orderly, basket-weave fashion, which is how the rest of your skin is composed, the fibroblasts throw down this overproduction of collagen haphazardly to get things closed up.
The result is an unorganised build-up of collagen beneath the top layer of your skin, which results in a raised scar; you will be at an increased risk of developing keloid scars if you have a darker skin type.
Keloids appear on your earlobe, chest, upper arms, shoulder, back, and face and can appear up to a year after sustained injury, and you may find them itchy or even painful.
You may have small pitted or divot scars if you have had chickenpox or acne; it is where the name pockmarks come from.
An atrophic scar is sunken and will occur as a depressed and well-defined lesion on your skin; they are thinner than your surrounding skin,
These sunken scars are caused by damage to your skin’s underlying fat or collagen cells, usually due to inflammation like cystic acne. There is not enough tissue to fill out your skin, so it causes depression on the surface.
Blemishes in the form of acne can leave you with lasting scars, especially cystic acne, which are painful bumps rooted deep in your skin.
When pus and bacteria collect and sit below your skin’s surface, they damage the deep layers of your skin and can cause scars which can take on various forms, which we discuss in more depth here.
These occur all over your body when you have extreme weight gain, such as during pregnancy.
When your skin has quickly expanded or shrunk, the connective tissues underneath may have become damaged, causing these stretch marks.
These appear as indented or raised lines that are either darker or lighter than the skin tone surrounding them.
To conclude. The naked truth
So as you can see, it’s not straightforward to treat when you scar your skin.
If you have scarred your skin, it is essential to understand the different forms of scarring, from immature to hypertrophic and keloid scars, so that you can treat them correctly.
Because how your scar heals depends on multiple factors, including the cause of your wound, its size and depth, the part of your body that was injured, and the wound care received.
There are four stages of wound healing, and repairing your skin is a highly complex and fragile process.
Failure to treat your skin correctly means that you may not progress through the stages of wound healing, which can lead to long-term scarring.
This is why it is essential to understand how scars are formed and the type of scars to correctly care for them and prevent further scarring.