Understanding Different Types of Scars and Their Unique Characteristics

TL;DR

• Scars fall into five main categories: keloid, hypertrophic, atrophic, contracture, and pigment‑related scars.
• Keloids grow beyond the original wound, while hypertrophic scars stay within borders.
• Atrophic scars are depressions like ice‑pick, boxcar, or rolling marks.
• Contracture scars tighten skin after burns or surgery and may limit movement.
• Early care-silicone, sun protection, and gentle massage-improves outcomes for all scar types.

What is a scar?

When skin tissue repairs itself, the new tissue is usually tougher and less elastic than the original. This replacement tissue is called a scar, a fibrous patch that forms after an injury heals. Scars differ in color, thickness, and shape depending on how the body responded to the wound.

How dermatologists group scars

Clinicians sort scars into groups based on three clues: how the tissue looks, whether it expands over time, and where it usually appears. Understanding these groups helps you pick the right treatment and set realistic expectations.

Keloid scar

Keloid scar is a raised, firm scar that grows beyond the original wound edge. It can be pink, red, or dark brown, and it often feels itchy or painful.

• Typical growth: Extends months after closure, sometimes reaching several centimeters.
• Common sites: Chest, shoulders, earlobes, and upper back.
• Risk factors: Darker skin tones, genetics, and tension on the wound.
• Treatment hints: Intralesional steroid injections, silicone gel sheets, laser therapy, or surgical removal followed by radiation.

Hypertrophic scar

Hypertrophic scar is a thickened scar that stays inside the wound margins. It’s usually reddish at first and may flatten over a year.

• Growth pattern: Swells quickly but rarely exceeds the original boundary.
• Common sites: Sternum after open‑heart surgery, knees after trauma, and areas under constant tension.
• Risk factors: Delayed wound closure, infection, and high tension.
• Treatment hints: Pressure garments, silicone sheeting, corticosteroid injections, and early scar massage.

Atrophic scar

Atrophic scar is a depressed scar that results from loss of underlying tissue. Acne, chickenpox, or surgical incisions often leave these sunken marks.

Common sub‑types

• Ice‑pick scar: Narrow (<2mm), deep puncture‑like pits, usually on the cheeks.
• Boxcar scar: Wider (2-5mm), well‑defined edges, often on the nose or cheeks.
• Rolling scar: Broad, undulating depressions that create a wave‑like texture, typical on the forehead.

These scars differ in depth and width, which drives the choice of treatment.

• Treatment ideas: Chemical peels, microneedling, laser resurfacing, and subcision for rolling scars.
• Prevention tip: Early use of topical retinoids after acne flare‑ups can limit tissue loss.

Contracture scar

Contracture scar is a tight, fibrous scar that pulls the skin together, often after severe burns or large surgical closures.

• Appearance: Thin, shiny, and may cause functional restriction.
• Typical locations: Joints (elbow, knee), face after extensive burns.
• Complications: Limited range of motion, discomfort, and cosmetic concerns.
• Management: Early physiotherapy, pressure garments, silicone gel, and in severe cases, surgical release or skin grafting.

Pigment‑related scar changes

While not a scar type per se, many scars develop discoloration that can be confusing. Post‑inflammatory hyperpigmentation (PIH) appears as darker patches, whereas hypopigmentation shows lighter spots.

• Triggers: Sun exposure, inflammatory acne, or laser treatment.
• Care: Broad‑spectrum SPF 30+ daily, topical vitaminC, and gentle exfoliation can even tone the color over months.

General scar‑care roadmap

Regardless of the scar class, a few universal steps improve healing:

1. Keep the wound clean and moist for the first 48hours - a hydrocolloid dressing helps.
2. Begin silicone gel or sheet application once the skin fully closes (usually day7‑10). Silicone reduces collagen overproduction, which is the main driver of thickened scars.
3. Protect the area from UV radiation. Sunlight intensifies redness and can lock in a scar’s color.
4. Massage gently in circular motions for 5‑10minutes, twice daily. This promotes collagen remodeling and softens tissue.
5. Consult a dermatologist early if the scar is expanding, painful, or limiting movement. Timely interventions like steroid injections or laser therapy yield better results.

Quick comparison of the five main scar categories

Frequently Asked Questions