Scars: formation, differential diagnosis, characteristics

Kristina (Novak) Musikhina , plastic surgeon, specialist in contour plastic surgery, graduate student of the Department of Otolaryngology at the Aleksandrovskaya Clinical Hospital, specialist in the field of aesthetic surgery and cosmetology

This is due to several factors:

1) high level of injuries and an increase in the number of surgical interventions for congenital malformations, cancer and other diseases in the maxillofacial area;

2) the increased demands of patients of surgeons and dermatologists for aesthetic results;

3) improving existing diagnostic and treatment methods;

4) influence on the psycho-emotional sphere, social status and social adaptation of patients.

An analysis of the distribution of rank values ​​in the structure of morbidity among dermatocosmetology patients indicates that in the overall structure of referrals, scar lesions of the face and neck account for 25.0%. The greatest number of visits for cosmetic defects occurs among women aged 31-40 years and accounts for 21.5% of the total number of patients. Among various social groups of the population, the highest level of attendance was found among people with intellectual work; the ratio of men to women is 33 and 67%.

As is known, the process of scar formation after damage to the surface layer of tissue during injuries, diseases, and operations is a biological pattern and is perceived as a “necessary evil” by both doctors and patients. One of the important features of the tissue scarring process is the fact that the final formation of the scar is completed after several months (and sometimes years), and is assessed by the patient at the same time.

Despite the rapid development of aesthetic medicine, the problem of improving the quality of scars still worries both patients and doctors. The main reason for this is the fact that the quality of the future scar is always influenced by three main groups of factors:

a) related to the patient;

b) depending on the specialist;

c) determined by objective circumstances (illness, injury, etc.).

And here the doctor is faced with the need for a systematic analysis of situations, which is objectively difficult and subjectively imperfect. Moreover, all attempts to influence the biologically determined process of scar tissue formation have strict limits on what is possible.

In this article, I would like to remind my colleagues about the stages of scar formation, modern treatment methods, as well as the differential diagnosis of scar types.

Types of scars

• Normotrophic scar: does not change the overall relief of the skin surface, has a pale color, normal or reduced sensitivity and elasticity close to normal tissues.
• Atrophic scar: located below the level of the surrounding skin, has a pale color, reduced sensitivity; occurs in places of tissue tension, when corticosteroids are administered into an immature hypertrophic scar, etc.

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• Hypertrophic scars are mature connective tissue protruding above the level of the surrounding skin, which is covered with a layer of epidermis. The main factors in the formation of a hypertrophic scar are the hyperergic reaction of connective tissue to injury and relatively unfavorable wound healing conditions.
  
• Keloid scars have an elastic consistency, an uneven, slightly wrinkled surface. Along the edges of the scar, the epidermis thickens and grows in the form of acanthosis, but never exfoliates or flakes off. The main symptom of a keloid is persistent progression, spreading to intact surrounding tissues.

What determines the characteristics of scars?

This characteristic includes general factors such as the patient's age. It is a well-known scientific fact that the activity of the repair process of tissue regeneration is highest in childhood and youth. In adulthood, the processes of wound healing and scar formation are much more inert, and in old age they even slow down.

Hereditary factor. Biologically determined reactions of the body that are triggered during the formation of wounds have their own genetically determined characteristics for each person. In recent years, data have been obtained on a genetic predisposition to the formation of hypertrophic and keloid scars (Negroid race).

Patient's immune status. The process of primary wound healing primarily depends on the state of the patient’s immune system. It is important to collect anamnesis and the presence of any chronic diseases in the patient. First of all, the specialist must find out whether the patient is taking any medications.

“Even the best plastic surgeon is powerless to help a person get rid of internal problems and complexes. It all starts with a change in thinking."

Literature:

• Anichkov N.N., Volkova K.G., Garshin V.G. Morphology of wound healing. – M.: Medgiz. –– 1951.
• Dermatol, 2001. – No. 137. – P. 1429-1434.
• Martin D., Umraw N., Gomez M., Cartotto R. Changes in subjective vsobjective bum scar assessment over time: does the patient agree with what we think? // J. Burn Care Rehabil. 2003. – No. 24. – P. 239-244.
• Anikin Yu.V. Prevention and treatment of post-burn and postoperative scars / Yu.V., Anikin, N.G. Kikoria // Annals of plastic, aesthetic and reconstructive surgery. – 2004. – No. 4. – pp. 35-36
• Belousov A.E. Scars as a global problem in plastic surgery / A.E. Belousov // Annals of plastic, aesthetic and reconstructive surgery. – 2004. – No. 4. – P. 41-42
• Kozlov V.A. Treatment of keloid scars / V.A. Kozlov, S.S. Mushkovskaya,
• Psycho-emotional disorders in patients suffering from acne / Monakhov S.A. et al. // Russian Journal of Skin and Venereal Diseases. – 2003.

Photos courtesy of the author.