Skin Issues: scars, stretch marks and pock marks
Scars, stretch marks and pock marks can be treated with a variety of techniques involving lasers, light-emitting devices, radiofrequency, injections and medications. Read ‘Beauty: The Ultimate Cosmetic Makeover Guide. Book 1: Face and Skin’ to find out more.
Scars are areas of fibrous tissue that replace normal skin after an injury has healed. A scar results from the process of wound repair in the skin and the deeper tissues of the body. It is a natural part of the healing process. With the exception of very minor scratches, every wound on the human body (for example, after accident, disease, or surgery) results in some degree of scarring.
Scar tissue is made of collagen, the same protein as the skin tissue that it replaces. The fiber composition of the protein is different in scars – instead of a random basket-weave formation of the collagen fibers occurring in normal tissue, in scars the collagen cross-links and aligns itself in a single direction.
This alignment of the scar collagen does not work as efficiently as the normal alignment. For instance, scarred skin is less resistant to the sun’s ultraviolet radiation. Also sweat glands and hair follicles are unable to form within scar tissue.
There are no magical cures for permanently scarred skin, but there are some treatments which may reduce the red or brown discoloration, or soften the thickening of scar tissue.
Types of scars and their treatments
Most scars will be red during the healing phase and in most cases this will fade spontaneously. Persistent redness in scars may respond to Pulsed Dye Laser treatment (page 209). Pulsed Dye Laser is also used to remove reddish blood vessel blemishes and birthmarks.
Some people may develop brown discoloration in patches of damaged skin. Generally this fades naturally over time, but if it persists for longer than nine months, it can be treated with a Q-Switched YAG laser or the minimally ablative Q-switched Ruby laser to help fade the pigmentation. See “Skin Therapy: laser skin therapies” on page 205.
Treatment with a prescription skin lightening cream such as hydroquinone 4% may also be useful. See page 232.
Raised (hypertrophic) scars
In rare cases scar tissue may over-develop, causing thickened, raised tissue. This is known as hypertrophic scarring. In some people this skin reaction is so extreme that even a scratched insect bite can result in a thick scar.
Generally, hypertrophic scarring will resolve naturally over a period of about twelve months. Treatment can speed up this process and for people in whom the scarring does not resolve, treatment can also help. People who have a tendency to this form of ‘over healing’ are usually aware of the problem, and if they tackle it early they will get the best results.
After finding out the patient’s medical history and inspecting other scars, a dermatologist or cosmetic technician can counteract the overgrowth of scar tissue with regular micro-injections of cortisone solution. If the problem is not addressed until after the scar has formed, the tissue may still respond to micro-injection treatment.
You can also buy, from pharmacies and drug stores, silicone sheeting designed to flatten raised scars.
Keloid scars are a more severe problem and the tendency is often genetic. It is more common in darker skin types. The classic feature of keloid scarring is that it grows and invades beyond the site of the actual injury. It is also often extremely sensitive and prone to itching. Keloid scarring commonly occurs in acne lesions on the chest and back.
Treatment for keloid scarring is similar to that described for hypertrophic scarring. This condition also has the tendency to recur over the years and require repeated courses of treatment. People prone to keloid scarring should consider preventative treatment as early as possible following injury. They should also avoid unnecessary surgery.
As discussed earlier, there are three layers to the skin: the epidermis (outer layer), dermis (middle layer) and hypodermis (deepest layer). Stretch marks develop in the middle layer. When the dermis is stretched or otherwise damaged it becomes less elastic, resulting in dark colored stretch marks. Over time these marks become pale in color and sink below the level of the rest of the skin.
Stretch marks are often the result of the rapid stretching of the skin associated with swift growth (common in puberty) or weight gain (e.g. pregnancy, muscle building, or fast gaining of fat). Although stretch marks are unsightly, they pose no health problem.
‘Pock mark’ may refer to:
Acne scarring—resulting from acne or infections such as chicken pox.
The scarring caused by smallpox.
For information on the different types of pock marks and their treatments, see our section on ‘Acne and Acne Scarring’, page 47 of ‘Beauty: The Ultimate Cosmetic Makeover Guide. Book 1: Face and Skin’.