Based upon a scar’s appearance, how it was triggered and how it develops, a number of different scar types may be seen. Hypertrophic scars typically occur after burns, are red, itchy and sit proud of the surrounding skin. However, they remain within the area of the original injury and typically respond to routine treatments. This is different from a keloid scar where a hard, red growth occurs and spreads incessantly outside the area of injury. Due to their genetic make up, keloid scars are more common in certain racial groups, tend to occur more often on certain body sites and have traditionally been very difficult to treat due to their tendency to reoccur. The Scar Team have a cutting-edge approach to difficult keloid scars. Sometimes scars can change in nature from hypertrophic to keloid with time. One scar can show elements of both hypertrophic and keloid sections across its surface and this may be due to factors like tension within the skin. At its extreme, a scar under lots of tension can produce a scar contracture that distorts the surrounding skin.
Whereas hypertrophic and keloid scars are both due to the excessive production of collagen and similar connective tissues, other scars are associated with the failure of production of scar tissue. These include stretched, or widespread, scars and atrophic scars. Within this group are acne scars which may be depressed from the surrounding skin. Often cosmetically unappealing, there are a number of approaches to these types of scars, from prosthetics and surgical scar revision to fat filling and minimally-invasive needling techniques.
Occasionally, a scar type may be difficult to classify as it may be symptomatic – for example, itchy – but still to evolve into a given scar type. This does not mean that an attempt cannot be made to treat the troubling symptoms, even if there is no clear ‘diagnosis’. Rarely, the appearance of scar after an operation can be unsatisfactory due to a poor surgical closure of the wound. This type of scar is often best addressed with a revision of the original closure and meticulous technique.