The aetiology of scars

Abstract

THE Oxford English Dictionary defines a scar as “the mark resulting from the healing of a wound or disease process” or “a fault or blemish remaining as a trace of some former condition or resulting from a particular cause”. Thus, as might be expected, a substantial proportion of scars arise either as a consequence of mishap or by reason of planned surgery. Some scars, such as striae gravidarum, arise ‘naturally’ as a consequence of changes in body shape. Apart from pregnancy, breast development in some women and gross obesity in’some individuals can produce similar appearances. The ageing process often causes non-congenital permanent wrinkles to form; the dermal matrix may also change-this, together with alterations in connective tissue fibres, may cause the skin to sag and become deeply furrowed by wrinkles. A few scars are induced deliberately for purpose of body decoration-the ritual markings of certain African tribes (Fig. 1) and the duelling scars popular with officers in the Prussian army during the nineteenth century (Fig. 2) afford examples. Tattooing can, perhaps, be regarded as a form of self-inflicted scar, although disturbance of the skin contours is usually minimal (Fig. 3). Accidental tattooing can arise as a consequence of trauma-impacted road dirt and penetration of the skin by detritus following an explosion are not uncommon (see Groves, these proceedings, Fig. 3). Sometimes trauma, particularly burns, causes a permanent reduction in hair density or permanent changes in skin pigmentation even though otherwise the skin appears to have regained a normal texture and appearance. infection is a common cause of scarring; boils and carbuncles due to staphylococcal infection frequently leave a permanent scar. Severe acne and vaccination afford other examples as do conditions such as leprosy. Possibly the majority of Fig. 1. Keloid scars deliberately produced for purposes of body decoration.