All scars are divided into the following types according to their outside and histological structure. They are normatrophic, atrophic, hypertrophic and keloid. The last two types make up a group of pathological scars.
Normotrophic scar (flush with the outer surface of skin) is the most harmless of all scars. It is formed as a result of adequate reaction of body after a surgery or injury. After a while they become thin, colorless and do not cause physical discomfort to the bearer. As a rule, this type of cicatrices does not need any correction, apart from the cases of aesthetical improvement of scar appearance or acceleration of color normalization process.
Fig.1. Abdominal normotrophic scars
Atrophic scar (lower level to the outer surface of skin) is formed as a result of injury or inflammation. They are divided into 3 subgroups according to their shape: ice pick or pitted scar, rolling scar and boxar.
Fig.2. Types of atrophic scars
А. BOXCAR scar
В. ICE PICK scar
С. ROLLING scar
The skin above the atrophic scars is thin, flaccid and often with cross-striation. Such scars are usually devoid of pigment and therefore look white. These characteristic features are conditioned by connective tissue defect, collagen and elastin deficiency – principal proteins forming the skin matrix.
Stretch marks, or striae, are basically a type of atrophic scars. Usually, stretch marks have the form of rolling scars, sometimes – boxcar. They are being formed for various reasons: pregnancy, sudden weight loss, continuous hormonal therapy, rapid growth during pubertal growth stage. Reasons are abundant, yet possess one common feature – rapture of collagen fibres or sudden decrease of collagen synthesis.
Hypertrophic scars, like keloids, overtop the surrounding skin, but do not lap over the damaged area. Collagen fibres acting as the scar substrate are wide and callous, but are located roughly on the parallel level with the skin surface. Hypertrophic scars are usually formed after surgical procedures and injuries of the flexible skin areas (of the joint area, for instance) resulting from serious inflammation, consecutive infection, decrease of local immunity, endocrine dysfunction, to mention a few.
Fig.3. Hypertrophic scar of achilles tendon region
Keloid scars or keloids
Keloid scars or keloids exceed the size of initial wound significantly. Massive proliferation of connective tissue in the areas of burns, wounds, post-inflammatory and post-surgery injuries is observed. Collagen fibers are located chaotically and knot-like, resembling a fingerprint. Despite their age, keloids can be active (growing) and inactive (stabilized). An active scar develops and causes pain, itching, numbness, emotional distress, and looks like a strained red scar, often with a bluish tint. Inactive keloid is not developing and does not bother the bearer from the subjective perspective, has a pink coloring or the one close to the color of normal skin. Keloids are typically localized in the regions of ear lobe, dekolletage, shoulders and back.
Fig.4. Post-burn keloid scars
A type of scar can be identified at the beginning of its formation considering mechanism and origin of injury, its localization and depth. However, only expert can influence the formation of a certain scar. Therefore, all cicatrices have to be observed and controlled by doctor.
The earlier the patient applies to doctor the more effective and faster the scar can be treated and corrected.