The impact of abnormal scarring

Scars are among the most common and frustrating problems after injury.1 Abnormal scars can cause unpleasant symptoms and be aesthetically distressing, disfiguring and psychosocially and functionally disabling.2

They often cause:2

  • Severe itching, tenderness and pain
  • Disruption of daily activities
  • Sleep disturbance, anxiety, depression
  • Post-traumatic stress reactions
  • Loss of self-esteem, stigmatization
  • Diminished quality of life

Psychological effects of scarring are not related to the severity of the scar.3

 

Scars – a common and undermanaged problem

Scars can have both – a physical and psychological impact on sufferers. Scars may cause physical problems like severe itching, tenderness or pain. A wound that crosses a joint or a skin crease may also lead to a scar contracture. Similarly with scars that continue to grow (hypertrophic scars and keloids), they can limit movement and can even be functionally disabling.

The physical appearance of some scars may also be more obvious as they can continue to be red and raised. Some problematic or abnormal scars may continue to grow past the wound boundaries or may take many years to soften and fade.

At times the psychological aspects can outweigh the physical ones for even the smallest of scars. For some people a scar is a constant reminder of the traumatic event that caused it. This can result in distress, poor self-esteem and difficulties in social situations, all leading to a diminished quality of life.3

People with scars may feel different and stigmatized and the reaction of others can be hurtful, particulary at impressionable ages. For children and teenagers, scarring can have a major psychological impact. At these ages, there is a need to feel normal or attractive and anything out of the norm can single out the individual. To be different because of scarring may lead to loss of self-confidence and feelings of inferiority.4

Scar management

To date, scars cannot be removed completely. But with effective management, the appearance and side effects of a scar can be improved significantly in most cases. In addition, the likelihood of developing abnormal scars can be reduced effectively if treatment starts shortly after wound closure.5

Any scar can be perceived as a personal problem. Some may learn to accept their scar, but many never forget it. It is widely accepted by psychologists that proactively treating to reduce the visibility of a scar can actually help boost self-esteem.

 

1. Atiyeh BS. Aesth Plast Surg 2007; 31:468–492
2. Bayat A et al. BMJ 2003; 326:88–92
3. Bayat A et al. Br J Hospital Medicine 2006; 67(8):634–639
4. Davies K et al. Nursing Times 2004; 100:5,40–44
5. Mustoe TA et al. Plast Reconstr Surg 2002; 110:560–571