A Patient Journey for those with Scars

Scars are a mark left on the skin, or within body tissue, where a burn, sore or wound has not healed properly and connective tissue has developed in its place. Scars are a very common natural occurrence and are all part of the body’s healing process. Scars can affect anyone at any age, with most people having at least one in their lifetime. Although there is no known cure for scarring, there are treatments available to help minimise the appearance of scars and lessen the symptoms associated with scarring.

Scarring can appear in a variety of forms, and can affect anyone regardless of age or gender; however, there are certain scars that are seen in some more than others:

Flat, pale scars - These can appear red or dark and raised initially after the wound has healed. Over time (usually two years or less) these scars become less visible, becoming flatter and paler. These are the most common type of scar.

Keloid scars - These appear as a raised lump over the wound and can in some cases be even bigger than the wound itself. They are shiny, hairless and usually domed in appearance. They are caused by too much scar tissue being produced at the site of the wound. Keloid scars most commonly affect people with darker skin.

Hypertrophic scars - These appear red and raised and they form along a wound. These scars can remain this way for years without fading.

Atrophic scars - Also referred to as ‘pitted’ or ‘ice-pick’ scars, these have a dipped or sunken appearance. These scars are commonly seen in those with acne scarring, where pitted scars are left where pustules (spots) have been.

Contracture scars - These are caused by the skin shrinking and tightening, usually after a burn, which can cause the skin to pull together restricting movement.

Stretch marks or striae - Stretch marks are caused by anything that encourages your skin to stretch at a rapid rate. Pregnancy, excessive weight gain, puberty and genetics are common reasons as to why stretch marks appear.

Symptoms of scars

Although scars can form anywhere, there are areas of the body which are more prone to scarring. Areas such as your chest, back, shoulder and ear lobe are more easily scarred due to their sensitivity. Symptoms of scarring can vary in their severity depending on the particular scar. The appearance and visibility of the scar can be the most impactful to people, with Keloid, Contracture and Hypertrophic being quite visually dominating. Further symptoms can include itching, tightness and restricted range of motion in the affected area. Many will experience some form of psychological distress as a result of having a scar, with depression being a common issue amongst scar patients.

If your scar is causing you any physical or emotional distress, it is important that you seek help and necessary treatment from your GP or healthcare professional.

Diagnosis

Almost all scars are diagnosed through a visual examination, with appropriate treatment being determined thereafter. Depending on the nature of your scar, you may be referred to a scar/burns centre for further assessment and treatment.

Treatment

Treatments can vary depending on the severity or nature of the scar. After an initial assessment, your GP can determine what treatment(s) you need, or if you may need to be referred to a specialist or a plastic surgeon.

Scars can change and develop from when it immediately forms after a wound heals, up until around 2 years later. Throughout this ‘maturity’ stage, GP’s will usually recommend massage and moisturisation as a treatment to prevent the scar tissue from excessively hardening or tightening. Further stretching techniques can also be effective in reducing the risk of your scar tissue tightening.

Other treatments which aim to flatten, soften and reduce the appearance of scars include Corticosteroid injections, which are primarily used for those with keloid and hypertrophic scars, pressure dressings, silicone gel sheets and in some cases surgery and laser therapy, should your GP or healthcare professional advise it.

Camouflage makeup is also a popular option for those who wish to cover their scarred appearance, especially if the scarring is on your face. Facial scarring can make people feel self-conscious, for example in those with acne, and so using makeup to cover or lessen the appearance of scars can prove very effective.

As well as camouflage makeup, there are many cases of scar patients camouflaging their scars by choosing to tattoo the affected area as a way of disguising the scar tissue.

Although more research is needed into the true effectiveness of some scar treatments, overall treatments can help reduce the appearance of scars and improve your range of motion if your scar is tight and restricting.

Psychological impact of scars

Scarring can, in many cases, cause deep emotional stress. Scars which affect the face (acne scarring for instance, or burns) can cause feelings of anxiety and can make people feel self-conscious about their appearance. As a result, those with scars can become withdrawn and isolated.

If your scarring is having an impact on your emotional wellbeing, please do contact and visit your GP as soon as you can.

Living with scars long term

Although scars will never completely disappear, they will fade and become less visible as time progresses. However, it is important to know how to care for your scar long term. Due its sensitivity, scar tissue needs to be protected when exposed to the sun as it can easily burn. Using a high factor SPF and covering it as much as possible during the sunnier months is important to ensure its protection. Living with a scar can be distressing and can in many cases cause social and emotional (psychological) problems. If you feel that your scar is affecting you in this way it is important to discuss this with your doctor. You can find further help and support from talkhealth’s scar community in the talkscars forum. talkhealth also supports the work of the British Skin Foundation, Changing Faces, Skin Deep, the British Association of Dermatologists, and the British Association of Skin Camouflage and would recommend their scar information and resources.

Sources used in writing this article are available on request.

Last revised: 12 September 2016

Next review: 12 September 2019