Traumatic Scarring

There are many potential sources of injury, such as sharp objects that penetrate the skin, thermal or chemical burns, and friction or scraping. Depending on the individual patient and the size and location of the skin injury, the resulting wounds may heal in multiple possible ways. These range from minimally visible scarring to severe thickening and tightening of the skin that can be disfiguring and/or prevent normal movement. Recent advances in treatment are improving the outlook for patients with traumatic scarring.

The Facts of Traumatic Scarring

Traumatic scarring may occur in people of all ethnicities and ages. Atrophic scars are lower and thinner than the surrounding skin. Hypertrophic scars are thickened and elevated above the skin but remain within the boundaries of the initial injury. Keloid scars are elevated and extend beyond the boundaries of the initial injury. Traumatic scars may affect patients physically, psychologically, and socially. Scar tightening (contractures), especially over joints, may limit normal movement and the ability to participate in normal activities of daily living. Disfigurement can affect the way people perceive themselves and the way others perceive them, possibly even leading to feelings of depression or anxiety. Traumatic scars can frequently cause pain, itch, and other abnormal sensations.

Diagnosis and Testing

Scar types and their associated problems are determined primarily by medical history and physical examination performed by a physician. Therapists may perform measurements to assess movement. Biopsies and laboratory tests may be of limited use.

Treatment

There is no cure for traumatic scarring, so injury prevention and effective early wound care are important to minimize scar formation. Physical therapy, pressure, and other treatments can help minimize contracture formation after injury. Medical teams that treat scars can include dermatologists, plastic surgeons, physical and occupational therapists, and psychologists. Other professionals may assist with scar camouflage. Common treatments include topical and injected corticosteroids, injected chemotherapeutic agents (eg, fluorouracil), silicone gel sheeting, cryotherapy with liquid nitrogen, and irradiation. Atrophic scars may be treated with tissue fillers. Lasers that target blood vessels are commonly used for reds cars, and newer ablative (destructive) and nonablative fractional lasers have advanced treatment substantially for some patients with traumatic scars, although multiple treatments are usually needed. Severe scars and contractures may require surgery.