A scar will result from any injury to the dermis. The skin layer is composed of two main components being the epidermis and dermis. For a superficial wound to the epidermis, usually no scar remains. During surgery or a traumatic injury through the entire layer of skin the scar will form and is fairly unpredictable. The scar may become a “normal” scar, a hypertrophic scar, or a keloid scar.
After skin injury the body begins the healing process by a proliferation of fibroblasts in a loose myxoid stroma. There is also an increase in small blood vessels giving a hyperpigmented or redish color to the skin. This normal red coloring to healing skin can be difficult to distinguish from a cellulitis or infection. As the scar matures collagen is laid down, and the fibroblasts decrease in number, as well as blood vessels in the area decrease, giving the skin more of a normal appearance.
A hypertrophic scar occurs when the scar remains thicker for an extended period of time. An increased amount of fibrous scar tissue may occur as well. The small blood vessels may become partially or totally occluded within the scar tissue giving a permanet dark red, or purple hyperpigmentation. This scar will remain confined to the surgical site or site of injury. They may also improve over time with treatment, although it is a slow process.
A keloid scar differs from a hypertrophic scar in that it will invade normal tissue and not only where the injury or surgical incision was made. This type of scar will have irregular borders. There is often some pain, numbness, burning, or itching with this type of scar. The scar can also become very hyperpigmented or dark. These types of scars are very resistant to treatment. The scar tends to occur in a higher percentage in african-americans.
Treatment is possible but can be unsuccessful, especially in keloid types of scars. Constant compression after surgical excision has shown to improve the results. An injection of a steroid has seemed to have one of the best results. The injection is usually with a long acting steroid mixed with a local anesthetic. The scar, especially if hypertrophic, may be best treated by a surgical procedure to remodel the skin. Almost 100% of keloid scars will return with surgical attempts at correction, which could result in even a larger scar.
One of the newer types of treatment for scars is with use of a silicone gel sheeting material. This seems to help shrink the size as well as improve the symptoms of pain, burning, and itching. The gel sheeting is worn over the wound 24 hours a day except for bathing and other minor activites. This is very safe treatment with the biggest complication being a dry dermatitis which usually improves after discontinuing the gel sheeting.
If you have a poor surgical scar or a scar following injury please discuss this with your podiatrist as soon as you become concerned for the best result.