Skin scarring

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A Bayat, specialist registrar in plastic and reconstructive surgerya (ardeshir.bayat@man.ac.uk),
D A McGrouther, professor of plastic, reconstructive and hand surgerya,
M W J Ferguson, professorb

^a Department of Plastic and Reconstructive Surgery, South Manchester University Hospital Trust, Wythenshawe Hospital, Wythenshawe, Manchester M23 9LT
^b Division of Cells, Immunology and Development, School of Biological Sciences, University of Manchester, 3.239 Stopford Building, Manchester M13 9PT

Correspondence to: A Bayat

Deciding whether to treat a scar or leave it alone depends on accurate diagnosis of scar type and scar site, symptoms, severity, and stigma

Each year in the developed world 100 million patients acquire scars, some of which cause considerable problems, as a result of 55 million elective operations and 25 million operations after trauma.1 There are an estimated 11 million keloid scars and four million burn scars, 70% of which occur in children.1 Global figures are unknown but doubtless much higher. People with abnormal skin scarring may face physical, aesthetic, psychological, and social consequences that may be associated with substantial emotional and financial costs. This article reviews the spectrum of abnormal scar types, a range of problems associated with scarring, and provides advice on assessment, treatment, and new therapeutic developments.

Summary points

Skin scars are the normal and inevitable outcome of mammalian tissue repair

Skin scarring covers a wide spectrum of clinical phenotypes from normal fine lines to abnormal widespread, atrophic, hypertrophic, and keloid scars and scar contractures.

Abnormal scars can cause unpleasant symptoms and be aesthetically distressing, disfiguring, and psychosocially and functionally disabling

Appropriate treatment depends on scar type and aetiology. Options vary from leaving alone to using a combination of corticosteroids, surgical excision, and radiotherapy

Recent advances in understanding of the biological basis of embryonic skin healing has led to the development of new drugs to prevent scarring

Method

This article is based on our scientific and clinical experiences in dermal scarring and on selected articles in recent issues of journals on plastic and reconstructive surgery, dermatology, and wound healing. Key terms included keloid disease, hypertrophic scars, and contractures, plus diagnosis, prevention, and treatment.