The skin is the largest organ of the body and is a seamless covering for blood vessels, muscles, nerves, tendons, and bones. Scars result when there is damage to the skin by trauma, friction injury, surgery, burns, infection, or chronic irritation. Scarring is the natural part of the healing process after injury; scars never go away or become non-scars.
A scar is made up of disordered collagen rather than the highly-structured collagen of undamaged skin. The scar process becomes maximal three to six months after injury. Over the next six months and for several years, scars begin to soften, lose the intense red inflammatory response, and may flatten. This is called scar maturation.
Hypertrophic scars are scars that are raised above the wound. These kinds of scars remain confined to the wound itself, and are raised above the wound and appear thick and red at the side of injury. These scare are caused by injury to the deep dermal layers of the skin and excessive amounts of collagen are produced during healing at the site of the injury, causing the thick, raised, red scars. Hypertrophic scars remain confined to the wound itself, differing from keloids in this respect.
The appearance of hypertrophic scars can improve over the course of six months to two years; however, the appearance of these scars may greatly impact self-esteem. Excessive itching is a frequent side effect and the scars may limit range of motion.
Hypertrophic scars may be treated with skin grafting, laser surgery, scar revision, injections, or compression garments. Shriners Hospitals for Children — Cincinnati pediatric surgeons are experts in treating hypertrophic scars and will work with the family and child to determine a treatment plan to achieve the best possible outcome.
Keloids are scars that expend beyond the margins of the original wound.
Anyone is at risk of keloid formation if they have any kind of wound to the skin, no matter whether the cause is a burn, surgery, ear piercing, or even acne. Keloids are the result of excess growth of scar tissue at the site of a healed skin injury and no one is sure what causes them.
While keloids are not usually harmful or dangerous, they can grow seemingly out of control and cause pervasive scarring and greatly impact self-esteem. When keloids get very large, they can reduce range of motion and impact day-to-day functions.
There is no single cure for keloid scarring that works for every patient, but several treatment options are available.
Unfortunately, many current therapies result in recurrence. Researchers at Shriners Hospitals for Children — Cincinnati are aggressively studying keloids and hope that their studies will shed light on the processes that cause keloids so that better, more effective treatments can be developed.
Compression garments are worn to help flatten the appearance of scars. These garments are tailored in the hospital to fit the child exactly and apply just the right amount of pressure.
Who needs pressure garments?
If the burn has healed in less than 14 days garments are usually not needed. The scare is managed with massage. Burns that take 14-20 days to heal are monitored closely for the need for garments. If the burn takes longer than 20 days to heal or was skin grafted, garments are always worn.