Precursors of scars and secondary skin elements
Secondary morphological skin elements appear as a result of the evolution of primary lesions. Some of them heal without a trace, while others lead to persistent changes:
- Erosion is a superficial defect within the epidermis. It heals without leaving persistent changes.
- Fissure is a linear rupture. Superficial fissures disappear without a trace, while deep fissures, reaching the deep sections of the dermis, are painful, bleed, and inevitably leave scars after healing.
- Ulcer is a deep defect disrupting the integrity of the epidermis, dermis, and underlying tissues. It forms as a result of purulent, productive, and specific inflammation, injuries, burns, trophic disorders, and tumor breakdown.
- Lichenification and vegetations are thickening of the skin with a sharp pattern (against the background of chronic inflammation, hyperkeratosis) and villous growths of the papillae. Vegetations make the skin bumpy and can occur at the site of ulcers.
- Specific lesions (e.g., lupus erythematosus foci) also leave superficial scars or lead to cicatricial tissue atrophy as an outcome of prolonged inflammation with follicular hyperkeratosis.
Morphological classification of scars
Depending on their location relative to the level of healthy skin, the following types of cicatricial changes are distinguished:
- Flat scars are at the same level as the surrounding undamaged skin.
- Atrophic scars are sunken and located below the level of the skin cover.
- Hypertrophic scars rise above the skin.
- Keloid scars are massive hypertrophic tissue of significant thickness that always extends beyond the boundaries of the preceding injury.
Features of keloid development
Keloid formations have a specific clinical picture. Patients often mistakenly perceive their initial manifestations as residual inflammation. They consult a doctor when the induration transforms into an exophytic formation or a protruding ridge.
- Appearance: A formed keloid has a cartilage-like density, significant size, and a cyanotic-red color. On smooth skin, it can acquire bizarre shapes as the process spreads along the skin tension lines (Langer's lines), completely losing the shape of the primary wound.
- Timing: A keloid can occur spontaneously 1–2 years after trauma, ear piercing, or surgery.
- Localization: They most frequently affect the face and neck. On the auricles, they form at the sites of sutures or earring piercings, typically 3–4 weeks after a protracted inflammatory process.
Differences between hypertrophic and keloid scars
Unlike keloids, hypertrophic changes develop according to different laws:
- Onset of growth: Tissue proliferation starts immediately after the wound surface heals.
- Area: The formation of excessive "excess tissue" is strictly limited to the area of the original wound and does not spread beyond its edges.
- Sensations: Subjective symptoms (itching, pain) are completely absent in the patient.
- Color evolution: The color change from pink to whitish occurs at exactly the same time as during the formation of a normal normotrophic scar.
Rehabilitation and correction of complications
After injuries (e.g., lower leg injuries), a frequent consequence is the formation of pathological scars and the development of desmogenic and myogenic contractures. The goal of outpatient rehabilitation is the resorption of cicatricial changes, the formation of an elastic scar, and the restoration of joint functions.
- Physiotherapy: Includes paraffin-ozokerite applications, warm procedures, ultrasound skin treatment, and electrophoresis of microcirculation-improving drugs.
- Massage: Manual massage, underwater shower massage, and exposure to a variable electrostatic field are used.
- Exercise therapy: Manual therapy, passive mechanotherapy, and positioning treatment are effective for stretching altered tissues. Active exercises strengthen muscles, while mechanotherapy and training equipment restore weight-bearing capacity.
Class and exam questions
How to distinguish a keloid scar from a hypertrophic scar?
The main difference is that a keloid extends beyond the boundaries of the initial wound and can appear 1–2 years after trauma. A hypertrophic scar is limited to the area of damage and begins to grow immediately after healing.
Why does a keloid scar acquire a bizarre shape?
In areas with smooth skin, keloid growths spread not along the contours of the original wound, but along skin tension lines (Langer's lines).
Which skin defects always leave scars behind?
Deep injuries that destroy the dermis lead to scar formation: deep fissures, ulcers, burns, as well as the consequences of specific inflammatory processes (e.g., lupus erythematosus).
What else to study on this topic
- Types of desquamation (foliaceous, lamellar, pityriasis) and crust formation (serous, purulent, bloody)
- Pathomorphology and histological variants of lipoma (fibrolipoma, soft lipoma)
- Specific skin lesions in lupus erythematosus: photosensitization and alopecia
- Desmogenic and myogenic joint contractures as consequences of trauma
Master the entire topic in the "Pathological Anatomy" course
This is a summary. The course covers everything tested in classes and exams.
- Complete study guide on "Scar Pathology" and 4,414 more pages of the subject
- Assignments and quizzes after every topic — just like in a colloquium
- AI tutor answers questions on the topic anytime
- 153 video lessons on the subject
Free video lessons: pathological anatomyShort lessons with study notes — no registration required.
Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.