A scar forms when an injury extends so deeply into the dermis that it destroys or cuts completely through a section of the fibrous collagen and elastin network that make up the flexible scaffolding of the skin. A scab, composed of dried blood, serum and other cellular matter, forms over the raw surface and under its protective shell, the skin goes to work to cover the scab with a new epidermis and bridge it with new collagen. Working from intact tissue around the wound and within surviving hair follicles, the skin generates epidermal cells that migrate over the laceration to create a new surface. At the same time, it sends out new fibers of collagen to fill in and stitch together the injured area. Instead of merely replacing the strands that have been lost or severed, the skin forges a strong bond with greater than normal amounts of collagen. Like the thread used to darn torn cloth, the new fibers are more numerous and closely gathered than the original strands. This collection of densely packed collagen threads is what is known as fibrotic tissue, or more popularly, “scar tissue.” Read on to learn more about 3 types of scars.
Atrophic scars: Atrophic scarring occurs when new collagen does not grow back fully into a wound, although it may collect around the sides and beneath the injured area. The result is a depression lined in fibrotic scar tissue. The most familiar examples of atrophic scarring are the pits and pockmarks left by acne or chickenpox.
Hypertrophic scars: Sometimes, a scar gets stuck in its early stage of development, when new collagen is rapidly growing. Fed by the blood vessels that repair injured skin, the collagen proliferates far beyond the point necessary to heal the wounded area. Pressed up by excess collagen, the resulting scar rises high above the surface of the skin. It is usually nodular (or bumpy) and colored an angry red from the excess blood vessels.
Keloids: Keloids are a more extreme version of hypertrophic scars. By definition, a keloid is a scar that grows beyond the boundaries of the original injury. The scar tissue behaves almost like a tumor because of its wild overgrowth of collagen. In appearance, a keloid is elevated, hard to the touch, with irregular clawlike margins. Anyone can get a keloid on any part of the body, although this type of scarring is more frequently found on people with darker skin types.
5FU and Kenalog are injectable treatments that may be used separately or in combination, depending on the treatment objective. 5FU/Kenalog mixtures improve the appearance of raised keloid scars when injected directly into the scar. Kenalog eliminates pimples or reduces the appearance of raised bumps from silicone injections when injected alone directly into the pimple or silicone.