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Scars

Nature Reviews Disease Primers volume 9, Article number: 64 (2023) Cite this article

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Abstract

Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients’ lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.

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Fig. 1: Presentation of various scar types.
Fig. 2: Phases of wound healing.
Fig. 3: Proposed treatment algorithm for hypertrophic scars.
Fig. 4: Proposed treatment algorithm for small and large keloids.
Fig. 5: Keloid lesions on the chest of a patient during treatment course.
Fig. 6: Clinical image demonstrating major keloid lesions formed in a patient with a positive family history for keloids, indicating genetic predisposition.

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Authors and Affiliations

  1. Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada

    Marc G. Jeschke

  2. Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children’s Hospital, Perth, Western Australia, Australia

    Fiona M. Wood

  3. Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia

    Fiona M. Wood

  4. Burn Center, Red Cross Hospital, Beverwijk, Netherlands

    Esther Middelkoop

  5. Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands

    Esther Middelkoop

  6. Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands

    Esther Middelkoop

  7. Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands

    Esther Middelkoop

  8. Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa

    Ardeshir Bayat

  9. Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France

    Luc Teot

  10. Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan

    Rei Ogawa

  11. Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany

    Gerd G. Gauglitz

  12. Haut- und Laserzentrum Glockenbach, Munich, Germany

    Gerd G. Gauglitz

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  5. Luc Teot
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Contributions

Introduction (M.G.J., F.M.W. and G.G.G.); Epidemiology (M.G.J., E.M., F.M.W. and G.G.G.); Mechanisms/pathophysiology (M.G.J., A.B. and G.G.G.); Diagnosis, screening and prevention (M.G.J., E.M., L.T., R.O. and G.G.G.); Management (M.G.J., E.M., L.T., R.O. and G.G.G.); Quality of life (M.G.J., E.M. and G.G.G.); Outlook (M.G.J., F.M.W. and G.G.G.); Overview of the Primer (M.G.J. and G.G.G.).

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Correspondence to Marc G. Jeschke.

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Jeschke, M.G., Wood, F.M., Middelkoop, E. et al. Scars. Nat Rev Dis Primers 9, 64 (2023). https://doi.org/10.1038/s41572-023-00474-x

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