Is It a Scar, Or Something More?

By Jennell Nelson, MD

Everyone knows that skin scarring occurs from small injuries and surgeries. There is a lot of confusion about the different types of scars. A scar appears different from normal skin in many ways. Texture, density and the color of the scar are the factors that make it more apparent to the eye. Scar revision is the process of making the scar appear more like the surrounding skin.

Occasionally scars enlarge spontaneously to form firm, smooth, hard growths called keloids. Keloids may be uncomfortable or itchy, and may be much larger than the original wound. They can arise soon after the injury, or develop months later.

In contrast, hypertrophic scarring is the same size as the original wound, but is only slightly thicker. Hypertrophic scars are not as irritable as keloidal scars. Stretch marks or stria are technically scars as well from the stretching of the skin, but are extremely hard to treat as there is a loss of collagen density. They again are unsightly due to the textural change that is apparent from the surrounding skin.

Dermatofibromas are hard lumps under the level of the skin. They usually seem to spontaneously develop. Most often dermatofibroma lesions are caused from puncture injury like insect bites or pencil stab injury. They can also be irritable and are most often found on the upper back, arms and legs. Occasionally patients on immunosuppressant medication (i.e. lupus patients, rheumatoid arthritis) may spontaneously forms several of these hard lumps, but they often pose no major health risk.

So what can you do to improve the cosmetic appearance of a scar? Many of my patients have experimented with camouflage techniques such as waterproof makeup and even professional tattoos to mask unsightly scars. Your treatment options over the counter include silicone gels or sheeting and topical alpha hydroxy creams.

But there are other treatments; many are even covered by your insurance. Your dermatologists can also shrink hypertrophic scars or keloids with a combination of triamcinolone injections and prescription tretinoin cream and pressure dressings.

More innovative treatments include vascular and fractionated CO2 laser treatments for lighter skin types. Advanced or recurrent keloidal scars can be treated with cryotherapy and radiation treatments which are safe for all skin types. There are options to minimize or improve scars even years after they were created.