Scar tissue forms as a normal part of the healing process after an injury. It replaces regular skin or other tissue that has been damaged. Mild or moderate scarring results in little to no issues, but excessive scar tissue can cause complications.
What is scar tissue?
Scar tissue contains the same collagen as undamaged skin, but the fibers are arranged differently. Instead of a basket weave formation, the fibers in scar tissue are aligned in parallel. This gives the scar a firm, fibrous feel.
Scar tissue does not contain hair follicles or sweat glands. Therefore, scar tissue that occurs on the skin will look glossy or hairless compared to surrounding skin. The lack of these structures also means that scar tissue does not tan.
What causes too much scar tissue?
Excessive scar tissue typically occurs due to:
- Large wounds or burns
- Deep wounds
- Surgery, especially when a significant amount of tissue is removed
- Radiation therapy
- Repeated trauma or injury to the same area
- Genetic conditions such as Ehlers-Danlos syndrome
- Skin conditions like acne
The amount of scar tissue that develops depends on factors like a person’s genetics, age, diet, and whether or not they smoke. Older people and smokers tend to develop more scar tissue.
What are the types of scar tissue?
There are several different types of scar tissue:
Hypertrophic scars
These scars are raised above the surrounding skin. They are red or pink in color at first but often improve in appearance after a few years. Hypertrophic scars contain large amounts of rigid, overexpressed collagen and can restrict movement.
Keloid scars
Keloids grow beyond the boundaries of the original wound and can expand over time. They may itch or become painful. Keloids are more common in darker skin tones.
Contracture scars
Also called skin contractures, these scars tighten tissue, which can impair physical function. Contracture scars often form after burns.
Adhesion scar tissue
Adhesion scar tissue binds tissues that are not normally connected. For example, they could join the abdominal organs together after surgery.
What are the effects of excessive scar tissue?
Too much scar tissue can cause a variety of problems depending on the location. It may:
- Restrict movement if it forms around joints
- Prevent normal muscular movements if it forms in muscle tissue
- Cause pain or numbness by putting pressure on nerves
- Block blood vessels, lymphatic vessels, or intestines if it forms internally after surgery
- Impair physical growth if large amounts form in children
- Cause disfigurement from large, thick scars
The effects of excessive scar tissue depend greatly on its location in the body. Some of the most problematic areas include:
Joints
Scar tissue around joints may make it difficult to move the joint through its full range of motion. The shoulders, knees, elbows and ankles are common sites.
Hands
Scarring around the fingers can impair fine motor skills. Contracture scars can cause the fingers to become fixed in bent or clenched positions.
Eyes
Scar tissue on the cornea, called a corneal scar, can lead to partial vision loss. In addition, disfiguring scars around the eyes may affect self-esteem.
Internal Organs
Adhesion scar tissue between organs may cause chronic pain, bowel obstruction or infertility.
Nerves
Scar tissue pressing on a nerve can cause chronic neuropathic pain, numbness, tingling or muscle weakness.
Uterus
Asherman’s syndrome is a condition where scar tissue forms inside the uterus, which can lead to infertility, changes in menstrual flow and cyclical pelvic pain.
How is excessive scar tissue diagnosed?
Doctors may diagnose excessive scar tissue through:
- A physical exam of the scar and evaluation of symptoms
- Imaging tests such as X-rays, CT scans or MRI scans
- Tests to evaluate nerve function
- Infertility testing
The testing used depends on the location of the scarring and the suspected complications it is causing.
What is the treatment for too much scar tissue?
Treatment options for excessive scarring include:
- Silicone sheets or gels – Silicon products are often the first-line treatment to flatten, soften and gradually shrink scars.
- Compression garments – Tight garments may help flatten and decrease raised or hypertrophic scars.
- Corticosteroid injections – Steroid injections into scar tissue can help flatten and soften keloid scars and reduce itching.
- Cryotherapy – Freezing scars with liquid nitrogen may help reduce scar bulk.
- Radiation – Low dose radiation prevents excessive fibroblast proliferation that causes scarring.
- Laser therapy – Laser resurfacing techniques remove the outer layers of a scarred area to improve texture and appearance.
- Surgical Scar Revision – Surgical removal or resuturing of the scar may improve function and appearance.
- Physical therapy – Stretching exercises and massage can help break down internal scarring around muscles and joints.
Treatment is tailored to the individual depending on the location of the scar, the person’s age and skin type. Several modalities may be combined for optimal results.
How can excessive scar tissue be prevented?
Methods to minimize scarring include:
- Using proper wound care techniques – Keeping wounds clean, moist and covered helps minimize scarring.
- Avoiding re-injury – Repeated trauma worsens scarring.
- Quitting smoking – Smoking impairs wound healing.
- Following surgeon’s directions – Precise surgical techniques minimize scarring.
- Silicone sheets – Applying silicone sheets after surgery reduces scarring.
- Sun protection – Sun exposure makes scars more visible. Use sunscreen on scars.
- Massaging scars – Helps realign collagen and flatten scars.
- Over-the-counter remedies – Onion extract, vitamin E and other products may minimize scarring.
While some scarring is inevitable whenever the skin is damaged, following wound care best practices can help prevent excessive, troublesome scarring.
Conclusion
Scar tissue is part of the normal healing process, but too much can cause functional problems and cosmetic concerns. Hypertrophic scars and keloids are examples of excessive scarring. Scar tissue around joints, nerves, blood vessels and organs may impair movement, sensation and bodily functions.
Diagnosis is made by physical exam and various tests depending on location. Treatment options include silicone sheeting, steroid injections, surgery and laser therapy. Preventing re-injury, using proper wound care and sun protection can help minimize scarring.