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Scars are areas of fibrous tissue that replace normal skin after destruction of some of the dermis. A scar results from the biologic process of wound repair in the skin and other tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound (e.g. after accident, disease, or surgery) results in some degree of scarring. Scar tissue is not identical to the tissue which it replaces and is usually of inferior functional quality. For example, scars in the skin are less resistant to ultraviolet radiation, and sweat glands and hair follicles do not grow back within scar tissue. A Myocardial infarction, commonly known as a heart attack, causes scar formation in the heart muscle which leads to loss of muscular power and possibly heart failure. However, there are some tissues (e.g. bone) which can heal without any structural or functional deterioration, and in fact bone tissue may be structurally stronger after a break. The word scar was derived from the Greek word eschara, meaning fireplace. How scarring occurs A scar is a natural part of the healing process. Skin scars occur when the deep, thick layer of skin (the dermis) is damaged. The worse the damage is, the worse the scar will be. Most skin scars are flat, pale and leave a trace of the original injury which caused them. The redness that often follows an injury to the skin is not a scar, and is generally not permanent. The time it takes for it to go away may, however, range from a few days to, in some serious and rare cases, several years. Various treatments can speed up the process in serious cases. Scars form differently based on the location of the injury on the body and the age of the person who was injured. To mend the damage, the body has to lay down new collagen fibres (a naturally occurring protein which is produced by the body). This process results in a fortuna scar. Because the body cannot re-build the tissue exactly as it was, the new scar tissue will have a different texture and quality than the surrounding normal tissue. An injury does not become a scar until the wound has completely healed. Transforming Growth Factors (TGF) play a critical role in scar development and current research is investigating the manipulation of these TGFs for drug development to prevent scarring from the emergency (and rather inappropriate) adult wound healing process. Abnormal Scars
Treatments for skin scars No scar can ever be completely removed. They will always leave a trace, but their appearance can be improved by a number of means, including:. Simple treatments Some suggest that using creams containing Vitamin E, taking vitamin E supplements, or including plenty of vitamin E in a diet from sources such as wheat germ, nuts, vegetable oils, eggs and green vegetables, can help speed up the healing process, and lessen the appearance of any scar afterwards. Other research, however, suggests that applying Vitamin E to post surgical scars does not reduce the size, shape, or color of scars and can, in up to one third of patients, result in contact dermatitis, allergic reactions, or other irritation that can worsen a scar's appearance. (Source: Baumann, Dermatologic Surgery, 1999.) There is also a suggestion that cocoa butter cream can be used to help heal scars, and to prevent the formation of keloid scars. Studies show that regular use of copper peptides can help remove abnormal skin cells along with exfoliation, alpha hydroxy acids, and beta hydroxy acids over the course of a year. Scar tissue is abnormal collagen, and the skin produces it as a quick fix for the skin to prevent infection. It takes the stem cells in the skin time to grow normal collagen though. Surgery Any surgical scar removal will always leave a new scar that will take up to two years to mature. Surgery can never remove a scar but can be used to alter its alignment or shape to make it less noticeable. Surgery can sometimes make the scar bigger, but improve its overall appearance. Surgery can sometimes be necessary to remove a scar on skin near a joint where it restricts movement, but it will leave another scar. In the case of hypertrophic or keloid scarring, surgery is not recommended, as there is a high risk of re-occurrence of possibly worse scarring following surgery. Laser Surgery & Resurfacing The use of lasers on scars is experimental treatment, the safety or effectiveness of which has not yet been proven. The redness of scars may be reduced by treatment with a vascular laser. It has been theorised that removing layers of skin with a carbon dioxide laser may help flatten scars, although this treatment is still highly experimental. Steroid injections A long term course of steroid injections under medical supervision, into the scar may help flatten and soften the appearance of keloid or hypertrophic scars. The steroid is injected into the scar itself and very little is absorbed into the blood stream, side effects of this treatment are minor. This treatment is repeated at 4-6 week intervals. Pressure garments Pressure garments should be used only under supervision by a medical professional. They are most often used for burn scars that cover a large area, this treatment is only effective on recent scars. Pressure garments are usually custom-made from elastic materials, and fit tightly around the scarring. They work best when they are worn 24 hours a day for six to twelve months. It is believed that they work by applying constant pressure to surface blood vessels and eventually causing scars to flatten and become softer. Radiotherapy Low-dose, superficial radiotherapy, is used to prevent re-occurrence of severe keloid and hypertrophic scarring. It is usually effective, but only used in extreme cases due to the risk of long-term side effects. Dermabrasion Dermabrasion involves the removal of the surface of the skin with specialist equipment and usually involves a general anaesthetic. It is useful with raised scars, but is less effective when the scar sunken below the surrounding skin. Collagen injections Collagen injections can be used to raise sunken scars to the level of surrounding skin. Its effects are however temporary, and it needs to be regularly repeated. There is also a risk in some people of an allergic reaction. Other treatments There are also a number of gel sheets available which are usually made from silicone, which can help to flatten and soften raised scars if worn regularly. Silicone, pressure, occlusion, topical cortisone and vitamin E have all been shown to decrease the collagen that forms scars. Patches and pads help but are unsightly so people tend to quit. A popular treatment among plastic surgeons is Scarfade, a silicone gel that improves the appearance of scars and prevents abnormal or excessive scar formation. Also chemical peels performed by a dermatologist using glycolic acid can be used to minimize acne scarring. Intentional scarring The permanence of scarring has led to its intentional use as a form of body art within some cultures and subcultures (see scarification}. Evidence of ritual scarring practices can be found in many tribes and cultures worldwide. See also | |||||||||
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