Scars 

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Skin lesions leaving a more or less visible scar after healing are unfortunately inevitable throughout life. Effective wound treatment, infection-free healing and one's genetic predisposition are decisive factors in minimizing the marks left by the injury.

  • A scar forms when not only the top layer of skin, but also the deeper skin layers are damaged.
  • The scars are permanent, but their appearance may improve.
  • The formation of a scar is the last visible stage of wound healing , which takes place in three phases: the inflammatory phase, the repair phase and the regeneration phase.
  • The formation of a scar can last up to two years, this is called the maturation period. During this period, you can act positively on the appearance of the scar. The earlier you start, the better the results.
  • Carefully treated scars are generally noticeably smoother, lighter and less protruding.

Outer scars normally form after damage to the deeper layers of the skin. A small cut or a slight laceration often damages only the upper skin layer, the epidermis. it is in this context that a new intact skin layer is formed from the lower layer of the epidermis, and closes the wound.

The same is not true when the lesion reaches the dermis , the intermediate skin layer: In this case, it then leaves scar tissue made up of collagen fibers devoid of elasticity. When forming a scar, protection takes precedence over aesthetics, because when the skin is damaged, pathogens can easily enter the body. It is therefore not surprising that the defenses try to close the wound as quickly as possible. It is therefore not uncommon for an irregular scar to form. The formation of a scar is the last stage, with a visible result, of healing.

Most of the time, a recent scar is red and raised. Over time, the scar tissue pales and sags slightly. The affected area remains pale and hairless, and generally looks smooth. This skin substitute is less elastic and continues to evolve for about two years. This can later lead to hardening and adhesions. The scar remodeling process can cause typical disorders such as

  • itching,
  • pulling sensation,
  • pains and
  • increased sensitivity to sunlight.

On the other hand, depending on their extent and location, the scars can be bothersome for aesthetic reasons. It is not always possible to cover them with clothing. In fragile regions such as the face, good management of the scar is therefore decisive.

To better manage skin lesions and avoid the formation of unsightly scars, it is necessary to understand the different phases of healing:

THE DETERSION PHASE

The vascular response is the body's immediate response to a skin attack. It is accompanied by rapid vasoconstriction which promotes haemostasis. Blood leaking from the damaged vessels into the damaged tissue coagulates to form a scab which will temporarily isolate the skin tissue from the environment. As soon as the wound appears, regional vasodilation occurs. Vascular permeability increases leading to a cascade of inflammatory phenomena associating erythema, edema, pain and local hyperthermia. Fibrin deposits and clots quickly cover the bottom of the wound, for the purpose of haemostasis. This phase culminates in the formation of the red thrombus: the clot.

The inflammatory phase begins quickly and lasts about 3 days. Neutrophils appear from the first hour of healing. This phase is essential to fight against the surrounding bacteria and to create an environment conducive to healing. The main purpose of inflammation is to bring on the injured area polymorphonuclear cells (microphages), then macrophages (phagocytosis) and plasma proteins which can:

  • Isolate, inactivate or destroy foreign elements.
  • Eliminate cell debris.
  • Prepare the ground to allow repair of the damaged tissue.

During this inflammatory phase, leukocytes infiltrate the site, eliminate waste products (clots and injured cells), release growth factors and pro-inflammatory cytokines which trigger the proliferative phase .

After a few days, the infiltration of neutrophils stops, giving way to macrophages which will remain predominant throughout the rest of the inflammation.

THE BUDDING PHASE

The second step is to rebuild the tissue and blood vessels. We speak of angiogenesis to name the process of growth of new blood vessels from pre-existing vessels. This phase begins after 2 to 3 days (after cleansing). The reconstruction of the dermis starts 3 to 4 days after the injury. It is called granulation tissue because of its granular appearance. These granules correspond to the multiple blood vessels that constitute it. During its formation, a concerted migration of macrophages, fibroblasts and blood vessels is observed within the lesion. The wound is red, shiny, moderately exuding and appears "fleshy".

THE EPIDERMIZATION PHASE

Epidermization (or epithelialization) is centripetal: it goes from the outside to the inside. By proliferation and confluence of keratinocytes, it begins both by multiplication from the edges and by migration within the budding tissue . Certain factors such as the regularity of the surface of the wound are decisive in the colonization by contiguity of keratinocytes. There is formation of a definitive basal membrane with proliferation in thickness to restore a normal epidermis. This process takes up to 21 days (average wound closure time). The color is often pink, the wound is slightly exudative and superficial.

THE HEALING AND REMODELING PHASE

When epidermization is complete, it is called scar tissue. Between the 25th and 30th day, the collagen of the primary scar is degraded and the scar is remodeled, becoming more supple, smoother and softer to the touch. This remodeling leads to the formation of the scar which will be final after 6 to 12 months. Note that the new tissue remains fragile (the tensile strength will not be greater than 70–80% of what it was before the appearance of the wound) and very sensitive to ultraviolet light, hence the need for a total screen on a scar for at least 2 years

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