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Scar

life science Maturity 11-13 Next article →

A scar is an area of fibrous tissue that replaces normal skin after an injury. This process is a natural part of wound repair in the skin and other organs. While some animals can undergo complete regeneration to regrow tissue perfectly, most mammals heal through scarring.

Novak 7 (5451438566)
Novak 7 (5451438566)

Except for very minor lesions, almost every wound from an accident, disease, or surgery results in some scarring. This happens when the body prioritizes closing a gap over perfectly recreating the original structure.

To understand how a scar forms, we must look at the biological mechanism of repair. When an injury occurs, the body first creates a clot to patch the damage. This clot acts as a provisional matrix, which is a temporary structure for healing. Following this, cells called fibroblasts begin a process known as fibroblast proliferation. These cells migrate to the site to lay down collagen, a structural protein.

Key processes contributing to the quasi-neoplastic expression of keloid pathobiology
Key processes contributing to the quasi-neoplastic expression of keloid pathobiology

In normal tissue, collagen fibers form a random basketweave pattern. However, during fibrosis, these fibers cross-link and align in a single direction. This dense, aligned collagen creates an inelastic, whitish scar wall that blocks cell communication.

A specialized type of cell called a myofibroblast plays a critical role in this process. Myofibroblasts are contractile fibroblasts that express a protein called alpha-smooth muscle actin (alpha-SMA). They are responsible for wound contraction, which helps pull the edges of a wound together. In some animal models, such as rats, myofibroblasts can make up as much as 70% of the proliferating fibroblasts. While these cells usually disappear within 30 days, they can remain in pathological cases. This presence can lead to excessive tissue growth and stiffness.

Scars vary significantly in their physical appearance and behavior. Hypertrophic scars are raised, red lumps caused by the overproduction of collagen. They typically appear within four to eight weeks after a wound closes under tension. Keloid scars are a more serious form of excessive scarring. Unlike hypertrophic scars, keloids can grow indefinitely into large, benign neoplasms, or non-cancerous growths.

Key processes contributing to the quasi-neoplastic expression of keloid pathobiology
Key processes contributing to the quasi-neoplastic expression of keloid pathobiology

Keloids are most common in people with dark skin and often appear on the chest or shoulders.

Another distinct type is atrophic scarring, which creates a sunken or pitted appearance in the skin. This occurs when the underlying structures, such as fat or muscle, are lost during the healing process. Atrophic scars are often associated with acne, chickenpox, or certain infections like Staphylococcus.

Atrophic scar of Ehlers Danlos syndrome
Atrophic scar of Ehlers Danlos syndrome

Some people also develop striae, commonly known as stretch marks. These are a form of scarring caused by skin stretching rapidly during growth spurts or pregnancy. Even the umbilical scar, or belly button, is a result of the healing process after the umbilical cord is cut.

The quality of scar tissue is often inferior to the original tissue. Because the collagen is so densely packed and aligned, scars lack elasticity. They also do not contain sweat glands or hair follicles. This means scar tissue cannot regulate body temperature as effectively as normal skin. Furthermore, scars are less resistant to ultraviolet radiation. In internal organs, scarring can be even more significant. For example, a myocardial infarction, or heart attack, causes scar formation in the heart muscle. This can lead to a loss of muscular power and potentially heart failure.

Research has revealed how external factors influence the healing process. In 2011, scientists discovered that mechanical stress can stimulate the formation of scars. Conversely, "stress shielding" can help reduce scarring. By 2021, researchers found that using chemicals to prevent fibroblasts from sensing mechanical stress allowed for scar-free healing. Understanding these mechanisms helps in developing treatments. For instance, chemical peels can exfoliate superficial acne scars. Doctors may also use filler injections of collagen to raise atrophic scars to the level of the surrounding skin.

scar revision
scar revision
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Atrophic scar of Ehlers Danlos syndrome.jpg
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Key processes contributing to the...
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