Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Resident's Page
2008:74:4;420-423
doi: 10.4103/0378-6323.42896
PMID: 18797087

Scars in dermatology: Clinical significance

B Anitha, S Ragunatha, Arun C Inamadar
 Department of Dermatology, Venereology and Leprosy, BLDEA's SBMP Medical College, Hospital and Research Centre, Bijapur, Karnataka, India

Correspondence Address:
Arun C Inamadar
Department of Dermatology, Venereology and Leprosy, BLDEA's SBMP Medical College, Hospital and Research Centre, Bijapur - 586103, Karnataka
India
How to cite this article:
Anitha B, Ragunatha S, Inamadar AC. Scars in dermatology: Clinical significance. Indian J Dermatol Venereol Leprol 2008;74:420-423
Copyright: (C)2008 Indian Journal of Dermatology, Venereology, and Leprology

A scar is a scar is a scar and only a scar if you don′t ask why"

- Shelly and Shelly

A scar is a fibrous tissue replacement that develops as a consequence of healing at the site of a prior ulcer or wound. Cutaneous scarring is a macroscopic disturbance of the normal structure and function of the skin architecture manifesting itself as an elevated or depressed area, with an alteration of skin texture, color, vascularity, nerve supply and biomechanical properties. [1]

Histologically, dermal scars are characterized by thickened epidermis with a flattened dermo-epidermal junction and an abnormal organization of the dermal matrix into parallel bundles of scar tissue collagen, as opposed to the normal basket weave pattern of dermal collagen. Scar collagen fibers have high proportions of type III collagen and fibronectin compared to the surrounding normal skin and are usually smaller and more densely packed. Elastic fibers are fragmented and abnormally organized in scars as compared to the normal dermis. Epidermal appendages such as hair follicles and sebaceous glands are usually absent in a scar. [1]

The pathogenesis of raised skin scars is unclear. Fibroblasts from hypertropic scars and keloids demonstrate excessive proliferative and low apoptosis properties. Fibrogenic isoforms of transforming growth factor β (TGF β 1, 2, 3 ) appear to play a central role in the pathogenesis process. TGF β 1 stimulates fibroblasts leading to proliferation and synthesis of procollagen RNA and hence, collagen formation. By upregulating the production of tissue inhibitor metalloproteinase and plasminogen activator inhibitor, TGF β 1 protects the collagen from degradation. [2]

Classification of Scars [3]

  1. Fine line scars: Surgical scars
  2. Wide (stretched) scars: These develop when fine line surgical scars gradually become stretched and widened. They are typically flat, pale, soft, symptomless scars. Abdominal striae of pregnancy can be considered as variants of these.
  3. Atrophic scars: These are flat or depressed below the surrounding skin. They are generally small and often round with an indented or inverted centre. They commonly arise after acne or chickenpox.
  4. Scar contractures: Scars across joints or skin creases at right angles are prone to develop shortening or contracture. They commonly occur after burn injury across joints or skin concavities.
  5. Raised skin scars:

    a. Hypertropic scars: These are raised scars that remain within the boundaries of the original lesion, generally regressing spontaneously after the initial injury. They are often red, inflamed, itchy, and even painful.

    b. Keloidal scars: These are raised skin scars that spread beyond the margins of the original wound and invade the surrounding normal skin. A keloid continues to grow over time, does not regress spontaneously and almost invariably recurs after simple excision.

  6. Intermediate scar: Scars that are difficult to categorize have been termed intermediate scars.

Dermatological Conditions Which Result in Scars

Many dermatological disorders can lead to cutaneous scarring. [Table - 1] enumerates a few of these conditions: [4]

Scars do not just occur as a consequence of the healing process, but also have other clinical significance. They may serve as a clue for diagnosis by their typical morphology or may give rise to various dermatoses while some dermatoses may mimic scars. These aspects of scars are discussed below.

Morphology of Scars as a Clue for Diagnosis[Figure - 1],[Figure - 2],[Figure - 3]

Scars seen in some of the conditions listed in [Table - 2] have a typical morphology [5] and their specific location or morphology may provide a clue for diagnosis of the dermatological condition.

Dermatological Conditions Occurring in Scars

Certain dermatological conditions arise from a scar and have a tendency to recur within the scar tissue. These disorders may occur in scars as a result of Koebner′s phenomenon, inoculation of infectious agents, metastases or long-standing changes in the scars [Table - 3]. In pseudoxanthoma elasticum, the disease process can be demonstrated in scars before the appearance of skin lesions. In such cases, a biopsy of the scar has been used for diagnosis of the disease. [7]

Dermatoses Mimicking Scars

Some dermatoses may clinically mimic a scar requiring careful examination and histopathological studies to confirm the diagnosis. The absence of history of prior injury should raise suspicion of these disorders [Table - 4].

Spontaneous Scarring and Pseudoscars

Scars can occur without any history of previous trauma. These tend to occur in predisposed individuals. However, there may be prior trivial trauma, hemorrhage [10] or dermatitis unnoticed by the patient. [11]

Atrophia maculosa varioliformis cutis: In this condition, spontaneous atrophic linear, rectangular or varioliform scars with sharp margins develop over the cheeks of children and young adults. [11]

Stellate and discoid pseudoscars: Stellate pseudoscars are white, irregular or star-shaped atrophic scars occurring over the sun-exposed areas of the forearms. It is commonly seen in elderly individuals aged 70-90 years. Brown pseudoscars are known to occur over the shins of patients with diabetic dermopathy. [10]

In most of the cases, except for cosmetic unacceptability, a scar is not a cause for much concern. However, a simple scar can be a site for the development of various dermatoses or it can undergo neoplastic changes over time. Hence, any long-standing scar with or without morphological changes, should be examined carefully and should be biopsied if necessary.

References
1.
Breathnach SM, McGrath JA. Wound healing. In: Burns T, Breathnach S, Cox N, Griffiths C, editors, Rook's textbook of dermatology. 7th ed. Oxford: Blackwell Science Ltd; 2004. p. 11.1-11.25.
[Google Scholar]
2.
Robson MC. Proliferative scarring. Surg Clin N Am 2003;83:557-69.
[Google Scholar]
3.
Bayat A, McGrouther DA, Ferguson MW. Skin scarring. Br Med J 2003;326:88-92.
[Google Scholar]
4.
Ghatan HEY. Morphologic eruptions. Dermatological differential diagnosis and pearls, 1 st ed. New York: The Parthenon Publishing Group; 1994. p. 37-45.
[Google Scholar]
5.
Shelley BW, Shelley ED. Scar. In: Advanced dermatologic diagnosis, 1 st ed. Philadelphia: W.B. Saunders Company; 1992. p. 1153-6.
[Google Scholar]
6.
Gupta AK, Rasmussen JE, Headington JT. Extensive congenital erosions and vesicles healing with reticular scarring. J Am Acad Dermatol 1987;17:369-76.
[Google Scholar]
7.
Lebwohl M, Phelps RG, Yannuzzi L, Chang S, Schwartz I, Fuchs W. Diagnosis of pseudoxanthoma elasticum by scar biopsy in patients without characteristic skin lesions. N Engl J Med 1987;317:347-50.
[Google Scholar]
8.
Ghatan HE, editor. General dermatological and dermatopathological pearls. In: Dermatological differential diagnosis and pearls. 1 st ed. New York: The Parthenon Publishing Group; 1994. p. 217- 51.
[Google Scholar]
9.
Rao AG, Jhamnani KK, Konda C. Nodular melanoma in a skin graft site scar. Indian J Dermatol Venereol Leprol 2008;74:159-61.
[Google Scholar]
10.
Colomb D. Stellate spontaneous pseudoscars, Senile and presenile forms: Especially those forms caused by prolonged corticoid therapy. Arch Dermatol 1972;105:551-4.
[Google Scholar]
11.
Kolenik SA, Perez MI, Davidson DM, Morganroth GS, Kohn SR, Bolognia JL. Atrophia maculosa varioliformis cutis. J Am Acad Dermatol 1994;30:837-40.
[Google Scholar]

Fulltext Views
2,211

PDF downloads
453
Show Sections