Cutaneous scarring: a clinical review

Abstract

Cutaneous scarring can cause patients symptoms ranging from the psychological to physical pain. Although the process of normal scarring is well described the ultimate cause of pathological scarring remains unknown. Similarly, exactly how early gestation fetuses can heal scarlessly remains unsolved. These questions are crucial in the search for a preventative or curative antiscarring agent. Such a discovery would be of enormous medical and commercial importance, not least because it may have application in other tissues. In the clinical context the assessment of scars is becoming more sophisticated and new physical, medical and surgical therapies are being introduced. This review aims to summarise some of the recent developments in scarring research for non-specialists and specialists alike.

Figure 1

The lines of Langer or relaxed skin tension lines.

Figure 2

A human myofibroblast, ×40 magnification. The nucleus is stained orange with propidium iodide and the filaments of α-smooth muscle actin are immunostained green.

Figure 3

The global scar comparison scale. The photographic records of each scar are placed side by side over a double-ended visual analogue scale which represents percentage scar improvement. The 0% rating equates to an assessors opinion that there is no detectible difference between the two scars; whereas the 100% rating on either side means that that particular scar is so improved that it is imperceptible from the surrounding normal skin.

Figure 4

A hypertrophic postsurgical scar.

Figure 5

Presternal keloid scar.