Understanding Different Types of Skin Scarring

Skin scarring is a common consequence of various injuries or inflammatory processes and can be categorized into three main types: tissue excess, tissue loss, and surface changes. Each type of scar has unique characteristics and treatment options, making it essential to understand their differences for effective management.

1. Tissue Excess Scars (Keloids and Hypertrophic Scars):
Tissue excess scarring occurs when the skin produces too much collagen during the healing process, leading to raised, thickened areas of skin. This type includes keloids and hypertrophic scars. Both types can develop after any injury, cut, surgery, or inflammatory process, such as acne. However, they differ in appearance and behavior. Hypertrophic scars remain confined to the boundaries of the original wound, while keloids extend beyond these boundaries. When you close your eyes and run your fingers over these scars, you will feel a raised area where the scar has formed. Certain individuals are genetically predisposed to keloids and hypertrophic scars. Treatments for these scars may include 5-FU injections, steroid injections, and pulse dye laser therapy, aimed at reducing scar tissue and flattening the scar's appearance.

An image of a keloid scar on the left wrist.

2. Tissue Loss Scars (Indented Scars):
Tissue loss or thinning results in depressions or indentations in the skin, such as stretch marks, ice pick scars, box scars, and rolling scars. Acne is a common cause of this type of scarring. These scars form when there is a loss of underlying tissue, causing the skin to dip or pucker. When you run your fingers over these scars with your eyes closed, you will notice a dip or indentation. The treatment options for tissue loss scars are varied and depend on the depth and type of the scar, ranging from laser therapy and microneedling to dermal fillers and surgical techniques.

3. Surface Change Scars (Texture or Color Changes):
Surface change scars involve alterations in skin texture or color without affecting the skin's contour. These changes may present as white spots (loss of pigment), brown spots (excess pigment), or red spots caused by visible blood vessels or vascular dilation. Surface changes are often perceived as scars, even though they do not involve true dermal scarring. When you run your fingers over these areas, no contour change is felt. Treatment for these surface changes varies: brown spots can be treated with topical creams and pigment-targeting lasers, red spots with vascular lasers, and white spots, which are challenging to treat, may require retinoid creams, light therapy, cryotherapy, melanocyte transplants, or surgical options.

Understanding the type of scar and its underlying cause is crucial for selecting the most effective treatment. Dermatologists can offer a range of therapies tailored to the specific scar type, helping patients achieve smoother, more even skin.