No matter how careful you are in life, you are bound to get minor cuts, scrapes, and wounds. When that happens, we often worry less about that immediate injury, and more about how it will look when it heals. Scars are the body’s normal mechanism for closing wounds and repairing injuries to the skin. Yet we often don’t have much control about how that scar will form and appear over time. Here are some common questions patients ask me about scars.
Is there a way to prevent a scar?
The only true way to prevent a scar is to not get injured in the first place. For instance, I often see patients with severe acne, with many cysts that can lead to scars. My main focus is to shut down the acne to prevent further scarring. We may improve the existing scars with time, but if we don’t prevent future ones, it can be futile. Of course, for planned injuries, such as surgeries, the best we can do is minimize the size of the cut (e.g. laparoscopic surgery vs. open) and choose areas with the least pulling to minimize the risk for a bad scar. Certainly, if a scar forms in a high-tension area (e.g. the shoulders), that extra pull on the skin puts you at greater risk for a stretched scar, even with your best efforts. In the end, every person’s body is different, and it can be unpredictable based on location, genetics, and luck.
How do scars form?
When the skin is injured, it sets off a cascade of events. Our body’s natural response is to inflame, build, and remodel the area to protect it. Scar tissue formation involves the building of collagen to reconnect the skin. The skin is the physical barrier between the outside world and the inside of our bodies. Our bodies are primarily concerned with sealing off that opening, rather than creating something cosmetically friendly. Scars may end up thin (atrophic) or thick (hypertrophic), or even grow unusually large beyond the cut itself (keloids, more common in African Americans).
What factors can impair wound healing?
In order to heal well, the body needs good circulation, nutrition, and rest. Certain medical conditions, such as vascular disease and diabetes, may limit circulation, especially in areas far from the heart, such as the feet and toes. Smoking and vaping hurt wound healing because nicotine constricts the vessels carrying blood flow. An insufficient diet that lacks essential nutrients, such as vitamin C and zinc, which help your body form collagen, can also impair healing.
If I cut myself, what are the most important steps to lessen scarring?
For simple cuts and scrapes, keeping a wound clean and locking in moisture are the most important steps you can take. This means gentle cleaning with soap and water, and application of a moisturizer, e.g. petroleum jelly (Vaseline). Usually, with no sign of infection, antibiotic creams (especially combination ones such as Neosporin) are unnecessary, and for some, may even expose people at risk for contact allergies (e.g. neomycin is a common cause of contact dermatitis).