What Are Scars?
Scars are a natural part of the body's healing process. A scar results from the biological wound repair process in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring.
Types of Scars
There are many different types of scars, including:
Hypertrophic scars. Caused by excess collagen production during healing, these scars do not extend beyond the wound margin.
Atrophic scars. These are indented scars that happen when your skin heals below the normal layer of skin due to a lack of tissue. They're common in cases of severe acne or chickenpox.
Keloid scars. Production of excess collagen causes this type of scar. However, unlike hypertrophic scars, they overgrow beyond the injury margin, forming a bulge on the skin.
Contractures. These are healing tight burn wounds.
Fine line scars. These are thin, flat scars that often result from minor injuries or surgical incisions.
Stretch marks. These scars happen when the skin stretches rapidly (for example, during pregnancy) or when the skin is under tension (near a joint, for example) during the healing process.
How Do Scars Form?
Scars form when the dermis (deep, thick layer of skin) is damaged. The body forms new collagen fibers (a naturally occurring protein in the body) to mend the damage, resulting in a scar. The new scar tissue will have a different texture and quality than the surrounding tissue.
Scar Healing Stages
Scars typically heal in four stages:
Hemostasis. Immediately after the injury, blood clots to stop bleeding and form a scab.
Inflammation. White blood cells come to the site of the injury to fight infection and clean the wound. The area may become red, swollen, and tender.
Proliferation. New tissue, blood vessels, and collagen fibers form to fill the wound. The scab may loosen or fall off during this stage.
Maturation. Collagen fibers reorganize, and the scar becomes smaller and paler. This final stage can take months or even years.
Itchy Scars
Several factors can make your scar itchy — for instance, when your body is trying to heal and regrow skin cells. The process mechanically activates itching because your nerves register an irritation on the skin. It is an attempt to draw your attention to check the area in case something is wrong. This response is similar to what you feel when something crawls on your skin.
Nerve fibers in your body may secrete some chemicals such as histamine, a natural itch inducer. Histamine is a chemical response to foreign substances. It protects the body from sudden exposure to outside elements.
Some scars, such as keloids, continuously grow into a hard bulge covered by smooth skin tissue. This part of the skin may be itchy when rubbed against things such as the fabric that makes your clothes. Although keloids may discolor your skin, they are not a danger to your health.
Scars from burns and contractures may make your skin stretch tightly. Healed burn scars may often trigger an itchy sensation due to the skin tightness.
Although old scars have already healed, avoid scratching them. Despite new tissues developing and hardening over time, the area remains sensitive. Scratching a spot may damage the skin, exposing it to new infections from dirt and bacteria.
Scar Treatment
Although scars cannot be completely removed, their appearance can be improved to some extent. Methods for improving the appearance of scars include:
Topical treatments. Vitamin E, cocoa butter cream, silicone gel, onion extract products, and several commercial skin care products such as Vaseline and Aquaphor that are sold over the counter may be somewhat effective in helping heal scars.
Surgery. Although it will not remove a scar, surgery can be used to alter a scar's shape or make it less noticeable. Surgery is not recommended in cases of hypertrophic or keloid scarring (raised scars), as it may cause the scar to return or become more severe.
Steroid injections. A course of steroid injections into a scar may help flatten it. Injections may help soften the appearance of keloid or hypertrophic scars. Injections of 5-fluorouracil (5-FU) or bleomycin into scars can help reduce the size of the scar and ease itchiness and pain.
Radiotherapy. Low-dose, superficial radiotherapy is used to prevent the recurrence of severe keloid and hypertrophic scarring. This treatment is used only in extreme cases because of potential long-term side effects.
Dermabrasion. This treatment involves the removal of the surface of the skin with special equipment. Dermabrasion is useful to blend in the irregularities of a scar whether it is raised or depressed. Microdermabrasion is a much less invasive form of dermabrasion but is minimally useful for very superficial scars.
Laser resurfacing. This procedure, similar to dermabrasion, removes the surface layers of the skin using different types of lasers. Newer types of lasers may achieve more subtle results by working on the collagen in the dermis without removing the skin's upper layers. This results in little downtime compared to traditional laser resurfacing and dermabrasion, which require longer recovery periods.
Filler injections. These treatments can be used to raise sunken scars to the level of surrounding skin. However, the effects of these injections are only temporary, and the procedures may need to be regularly repeated. Newer forms of injectable fillers are now on the market and may be an option for some people.
Microneedling. Many small puncture holes are made into the superficial skin to stimulate collagen production and even introduce collagen stimulators or other products to try to reduce the appearance of scars.
Cryosurgery. This freezes the scar to reduce the size of the scar. It also reduces pain, itchiness, hardness, and discoloration. This may be combined with steroid or 5-FU injections.
Platelet-rich plasma (PRP) therapy. This office procedure is becoming increasingly popular in treating scars, particularly atrophic scars. PRP uses your own blood plasma to stimulate your body to produce collagen.
Itchy scar treatment
It is unlikely that your old scar will go away, but some of them will slowly fade off with time. The itching goes away by itself.
When itching becomes persistent, you may use these methods to reduce it:
- Apply anti-itch creams (on overly itchy scars).
- Use cool compression on the scar to reduce the itchy sensation.
- Gently wash the scarred area to remove any extra dead cells that may be causing additional irritation.
- Apply moisturizing creams and oils that contain Vitamin E. It can help reduce irritation that occurs on dry skin.
- Massage and apply firm pressure on the itchy area using lotion. It can help reduce the itchy feeling.
- Distract yourself to keep your mind off the itch with mild exercise, games, or other activities.
- Trim your fingernails short if you tend to scratch to avoid further irritation.
- Use unscented laundry detergent to avoid skin irritation.
- Use sunscreen or wear appropriate sun-blocking clothing.
Some medications may help you reduce irritation, such as:
Sleeping pills. If the itching is uncomfortable and keeps you up at night, consider getting safe sleep medications from a doctor to help you sleep through the itching.
Gabapentin. This medication works by acting on the part of the brain involved in controlling itchiness.
Antihistamines. Taking antihistamines may work by blocking the histamine produced. Some antihistamines are available over the counter. They include Benadryl, hydroxyzine, cetirizine, and loratadine.
Consider talking to a medical professional before taking any oral medication. Apart from getting the correct dosage, it may also help avoid any allergy-inducing medication.
