Topics discussed on this page include:

Epidermis, Dermis, Lacerations
Scars, Cicatrix, Hypertrophic Scars, Keloids
Silicone sheets, Steroid Injections, Scar Revision Surgery

There are basically two layers of skin--the epidermis (the outermost layer composed largely of tough, dead skin cells that act as a barrier to the environment) and the dermis (the deeper layer that houses the nerves, blood vessels, sweat glands and so forth). The thickness of these layers varies greatly around the body, with the bottom of the foot being noteworthy for having a very, very thick layer of epidermis compared to most of the rest of your skin. 

Any time the skin is lacerated (a medical term for being cut), it could create a scar--a permanent line where the skin was cut indicating imperfect healing. 

At times, scars may present a problem, whether because of an unsightly appearance, because of their limiting motion of a muscle, tendon, joint or other deep structure, or because of discomfort.  So at this point its probably a good idea to differentiate between the different types of scars, and the factors that go into determining what type of scar may develop. 

The first factor that must happen for a scar to develop is that a laceration has to extend at least into the dermis for a scar to develop.   If the laceration is not deep enough, a scar won't typically develop. 

If a scar is to develop, it may simply be a normal, typical scar, known in medical terms as a cicatrix.  The appearance is usually that of a simple persistent line where the original laceration was.  Most scars will be less elastic and will contract somewhat compared to normal skin.  

Two types of problematic scars are hypertrophic scars and keloids.  As both hypertrophic scars and keloids are atypically enlarged compared to a regular scar, they are often confused.  This is really too bad because there are differences, and their implications on treatment are different

So what's the difference?  

• Hypertrophic scars are typically light in colour.  Keloids are typically relatively darkly discoloured.   

• Hypertrophic scars typically do not extend beyond the edge of the original scar.  Keloids typically do extend beyond the edge of the original scar.  

• Hypertrophic scars typically do respond to medical treatment.  Keloids typically do not respond to treatment. 

Treatment:

The best way to treat a scar is before it develops.  If you're undergoing surgery, the incision must be carefully planned to avoid areas of tension and pressure that will tend to create more problematic scars.  Proper surgical technique in terms of tissue handling and suturing is essential.

In cases of an unplanned skin injury such as a laceration, proper medical treatment is very important to avoid unnecessary scar formation.  The wound must be properly cleaned, antibiotics may be used, the tissues must be handled correctly , the wound must be properly sutured and dressed.  The patient may be given Vitamin E cream to apply to the wound. 

The patient must be certain to get enough vitamins orally, particularly vitamins A,C, and E.   And the patient should take care not to contaminate the wound, (infections typically worsen scar formation), and the patient should not put unnecessary stress, strain or tension on the wound as it heals.   

Once the tissues are healed and a scar has developed, however, there are still some things that can be done. None-invasive silicone sheets and silicone gels are new treatments that have offered patients tremendous improvements.  Steroid injections may also be helpful.  Scar revision surgeries are the last resort.