Unlike your normal skin tissue, scar tissue has a different form of collagen structure. The collagen in your unharmed skin is laid out in a reticulate formation, with the fibres crisscrossing each other. On the other hand, scar tissue collagen is laid down in a unidirectional manner. It can take up to two years for a scar to reach full maturation and may only resolve to be 80% as strong as surrounding healthy tissue. Therefore, sun protection should be of upmost importance from the very beginning of the healing process.
For the scar tissue, the danger lies in:
Degradation of non-mature collagen tissue
Post inflammatory hyperpigmentation
In this formation, the scar tissue is weaker than the normal skin, possessing less durability and elasticity. Exposure to the ultraviolet section of the sun’s rays will damage these fibres, making the collagen fibres not align as neatly which may cause the scar to thicken and result in an unattractive scar.
Exposure of new scar tissue to the sun also more often than not results in hyperpigmentation of the area, due to the increase of inflammation and the effect it has on melanogenesis (the formation of melanin). Melanin is produced in an attempt to protect the vulnerable new tissue. Those with a darker fitzpatrick skin type are at higher risk of developing hyperpigmentation. In simpler terms, this means that the area of and around the scar becomes darker than the rest of your complexion and may appear brown to a deep red. Cosmetically, this is unwanted and it remains a treatment concern for many dermal clinicians in Melbourne, due to the harsh UV of the Australian sun.
HOW DO YOU PROTECT YOUR NEW SCAR FROM SUN EXPOSURE?
With what we have gleaned from this article so far, it is safe to say that the scar needs to be carefully looked after in a bid to prevent a breakdown of the wounds delicate infrastructure.
We recommend that you keep your scar covered with light gauze or cloth because even the most inconspicuous of exposures to sunlight will exert their damage in an accumulative manner.
On any scar that is exposed to the light opt for UV protection topical creams with a sun protection factor of 30 or above (SPF 30), ensuring that the label reads, ‘broad spectrum’. These filter out the harmful parts of the spectrum of the sun’s light, protecting your new scar.
And if your scar has shows signs of darkening there are professional treatments and home care products to lighten which we will discuss in future articles.
Hasan, A. T., Eaglstein, W. and Pardo, R. J. (1999), Solar-Induced Postinflammatory Hyperpigmentation after Laser Hair Removal. Dermatologic Surgery, 25: 113–115.
When you skin is injured, there are subtle mechanism working feverishly within you to patch it up so that the integrity of your body is maintained. The end result is that you will have a scar to remind you of your journeys.
What is interesting, however, is the fact that your scars might look completely different from those that you sister is exhibiting. Weird, right? I mean, it is all skin and it should heal in a similar way. Wrong!
There are different kinds of scars and there are underlying causes that lead to the dissimilar ways of scarring.
The three main types of scars include:
Hypertrophic scars are the kinds that grow out over the surrounding skin due to inadequate control of the proliferation of connective tissue. This causes the scar to become distended but still maintaining the bounds of the wound.
During – and even well after – the development of the hypertrophic scars, the patient is bound to feel pain and a good amount of itchiness on and around the scar. The fact that a lot of fibrous tissue is deposited at the site of injury means that the hypertrophic scar becomes tough and appears cosmetically repulsive.
Over time, though, hypertrophic scars can degenerate and take on the appearance of near normal scars.
Keloids differ from hypertrophic scars in a way that they can occur any time after the wound has healed. They then proceed to burgeon, extending out over the normal skin and surpassing the boundaries of the original wound.
These kinds of scars are really a burden psychosocially to those who have them because of the cosmetic and aesthetic damage that they cause. Keloids are also more common in people with dark pigmented skin.
Keloids can continue to expand and need to be dealt with; surgery often being the go to measure.
Atrophic scars differ from the above pair in almost every way. The hypertrophic and keloid scars involve the over-proliferation of collagen beneath the skin. On the other hand, atrophic scars involve little or no collagen under the skin that is affected. The result is a depression in the skin, kind of like a pit.
Healing from acne vulgaris is a common manifestation of these kinds of scars. All these kinds of scarring pose quite a challenge to a number of dermal clinicians to treat effectively.
Niessen, F. B., Spauwen, P. H., Schalkwijk, J., & Kon, M. (1999). On the nature of hypertrophic scars and keloids: a review. Plastic and reconstructive surgery, 104(5), 1435-1458.
Ketchum, L. D., Cohen, L. K., & Masifrs, F. W. (1974). HYPERTROPHIC SCARS AND KELOIDS A Collective Review. Plastic and reconstructive surgery, 53(2), 140-154.
The detriment of smoking is not only pigeonholed in the lungs. The active ingredients in the tobacco pass into the bloodstream and continue to exert their effects on your system. And what active ingredients are we talking about?
Nicotine is the addictive ingredient of tobacco and is what the smoker really craves. But while you might be relaxing at a long beach, lifting that cigarette to your lips before luckily striking that match, keep in mind that procedure you have next week.
This is because nicotine is a potent vasoconstrictor. The amount in a couple of cigarettes cuts down blood flow by about 30 per cent. Half of this blood flow will be restored in about 10 minutes but the tissue closer to the skin will have lower levels of oxygen for close to an hour.
When an individual ups this smoking to a pack a day, this vasoconstriction will take effect for the full 24 hours of a day! It should be noted that oxygen is required for the various processes involved in the optimal healing of wounds.
Lower oxygen levels can cause the formation of free radicals. These molecules disrupt the normal function of cell membranes, DNA and enzymes by stealing electrons from their constituent atoms in their lifelong bid to become whole again. This leaves many cells irreparably damaged and enzymes in a non-functional state.
Apart from causing the vessels to constrict, nicotine can bring about ischemia in the wounded area by making the platelets stick together in the small vessels. This greatly reduces the arrival of all the vital blood corpuscles and compounds needed for wound healing.
HOW DO THE OTHER CHEMICALS IN CIGARETTE SMOKE AFFECT WOUND HEALING?
Whilst nicotine is wreaking its havoc in your body, carbon monoxide and hydrogen cyanide are throwing their own kind of party too.
Carbon monoxide cuts down on the supply of oxygen; a gas that we know for sure is vital in the replenishment of energy at the wound site in order to spur on the necessary repairs to the tissues.
On the other hand, hydrogen cyanide interferes with the enzyme activity at cellular level. The chemical inhibits the enzymes – and there are plenty of those – that speed up the recovery processes.
So put together, all these chemicals in cigarette smoke will make the healing process longer than it should be. Numerous studies have shown that smokers take longer to heal after surgeries, be it cosmetic or otherwise.
WHAT YOU SHOULD DO
Before you go in for any procedure, you should stop smoking for at least two weeks. This will ensure that your body has cleansed itself of the cigarette chemicals that would have otherwise interfered with the wound recovery process.
You should also endeavour to resist the urge to light one up after the surgery because the same reasoning applies.
Apart from pocketing your pack and putting away your lighter, you should endeavour to consume foods rich in antioxidants like vitamin C. As an antioxidant, this acid – readily available in fruits – neutralises the hazardous effects of the free radicals, leaving the wounds to heal nicely and quickly.
So, in your recuperation period, it seems to make sense to replace those cigs with figs, no?
Vitamin E is also an important antioxidant and is vital in making sure that the integrity of the cell membrane remains intact. This prevents cell damage and ensures that the healing process moves on without a hitch.
Silverstein, P. (1992). Smoking and wound healing. The American journal of medicine, 93(1), S22-S24.
MacKay, D. J., & Miller, A. L. (2003). Nutritional support for wound healing. Alternative medicine review, 8(4), 359-378.
If your skin gets punctured when you have been mucking around in the back yard or if you have undergone surgery, you are definitely familiar with the pain of a healing wound. No doubt there are some wounds that will present a grisly sight and need to be taken care of constantly. Others need nothing more than a Band-Aid and you’re good to go. What makes these wounds so different? What is your body doing that makes one wound so unpleasant and uncomfortable and another just a minor inconvenience? We are here to find out.
NOT ALL WOUNDS HEAL THE SAME; HERE ARE THE TYPES
There are different types of wounds and depending on the circumstances that you present with, they will heal in dissimilar ways.
Primary: This is the kind of wound that requires closure or contraction and then goes ahead to heal naturally provided that you are in perfect health and there are no underlying factors to place hurdles in the healing process. The wound is closed up with sutures, skin adhesive or clips and then left to its own devices, sure that it will heal.
Secondary: Wound healing in this category is a whole other problem to deal with. This is because they edges of the wound cannot be brought together and as such the healing has to go on with the wound open. It is mainly for this reason that such kinds of wounds are prone to infection, further complicating the healing process.
Tertiary: This is also known as delayed primary. In this form of healing, the wound is observed for a few days to ensure that all the infected tissue has been excised. Subsequently, the wound can be contracted as in the primary method and left to heal. Hence the term ‘delayed primary’.
WHAT EXACTLY HAPPENS AS THE WOUND IS HEALING?
The inner workings of the healing process are complex. But since this complexity helps us enjoy life, why not go into it and take a look around. Careful, though, there are plenty of biological repairmen working feverishly down here. First and foremost, it should be noted that the body has organized the healing process into a number of phases. This order ensures that your wound heals in an efficient and clean manner, devoid of infection. Though these stages are identifiable, they are not sequentially discrete. That is to say, there is significant overlap amongst the stages, with some starting when the other is not yet complete.
Blood is the stuff of life. When you are injured, you begin to leak this fuel upon which your life is driven. It is for this reason that the first thing your body does is to stem the flow of the blood from your body. When the platelets in the blood come into contact with the wounded area, they summon a cascade of cytokines, growth factors and other pro-inflammatory mediators. The resulting effect is that there is formation of a fibrin plug – commonly referred to as the clot – so that no more blood leaves the body.
The platelet-derived growth factor (PDGF) calls out to the neutrophils, macrophages, fibroblasts and smooth muscle cells. Transforming growth factor beta (TGF-β) summons more cytokines and monocytes. This stage lasts 4 to 6 hours.
When the blood has stopped flowing, inflammation starts to occur. During this stage, the vessels in the affected area become more permeable, allowing serous fluid to leak into the affected area. This permeability also allows monocytes to cross capillary walls and move to the injury site.
Since the skin is punctured, bacteria see this as an opportunity to launch an attack. Not if the neutrophils have anything to do with it! Their numbers in the wound build up with the primary aim of phagocytosis of such bacteria. What you see as pus is the neutrophils filled with dead bacteria.
The stream of aforementioned monocytes is then activated into macrophages which are phagocytic towards these used neutrophils and other non-viable cells, thus cleaning up the wound. The macrophages also release more growth factors, enhancing the healing process. Inflammation results in a clean wound bed, a process lasting around 3 days.
3.REGENERATION AND PROLIFERATION:
This is the longest part of the wound healing process, becoming more pronounced on the third day though starting during the period of inflammation. It can last up to a fortnight or more. The aforementioned fibroblasts are responsible for generation of the extracellular matrix. They are supported by epithelial and smooth muscle cells which are called upon chemotaxically by the PDGF and TGF-β.
Vascular endothelial growth factor (VEGF) moves to the wound site due to the low levels of oxygen known as a hypoxic environment. Formation of new capillaries occurs at the same time as the fibroblast proliferation to ensure that these cells have plenty of oxygen to work with in the development of new tissue.
The fibroblasts form collagen to cover the deficit of tissue at the injured site. In the primary wound, this is complete by day 5 or 6. In the secondary wound, granulation has to occur in a bid to fill up the gaping hole. This granulation tissue is slow to form and it needs the patient to be in peak nutritional status.
Epithelial cells contract around the wound so as to cover it up, closing it off from the outside world. In the secondary wounds, this has to wait until the gaping wound is filled up with the granulation tissue.
This stage goes on for a longer time, taking months and even years. During this period, the fibroblasts strike a balance between depositing collagen and breaking down the wound matrix with matrix metalloproteinases. At the end of it all, the final scar usually has about 80 per cent of its original tensile strength.
It should be noted that sometimes this balancing act does not quite come off, resulting in the formation of keloids and hypertrophic scars. As well as being painful at times, these kinds of abnormal scars are a blemish cosmetically.
And that is how your body deals with the various injuries that you experience. A complex process that it manages to pull off every time you have an accident or go under the knife.
Wound Healing. (2018). [image] Available at: https://woundeducators.com/phases-of-wound-healing/ [Accessed 14 Mar. 2018]. Hunt TK, Van Winkle W. Normal repair. In: Hunt TK, Dunphy JE, eds. Fundamentals of wound management. New York: Appleton-Century-Crofts, 1997. Verhamme P, Hoylaerts MF. Haemostasis and inflammation: two of a kind? Thromb J 2009; 7: 1e3.Winter GD. Formation of the scab and the rate of re-epithelialisation in the skin of the young domestic pig: Nature 1962; 193: 293e4. Martin P. Wound healing—aiming for perfect skin regeneration: Science 1997;276:75–81.Singerand AJ, Clark RA. Cutaneous wound healing. N Engl J Med 1999;341:738–46.
Although the complex mechanism behind healing and the formation of scars is quite capable of full recovery, it does require plenty of support. This support comes in the form of nutrients from your diet.
What does your diet have to do with this? Well, the skin is a sensitive organ and, seeing as it is the largest one you have, it requires a lot of nutriment to rebuild and repair to return as close as possible to the condition it was in before the injury.
Many of the different growth factors that are responsible for healing of wounds need precursors and regulators that govern their function. All these are the result of various biological compounds that are sourced from the diet. It is no wonder, therefore, that there are plenty of recommendations out there to have a diversified and healthy diet in order to have a glowing skin. Many conditions that denigrate the integrity of the skin are a direct result of poor diet and the ensuing malnutrition. Kwashiorkor, marasmus, pellagra and scurvy are a few of the well-known skin-affecting conditions whose roots lead back to malnutrition.
SO WHAT EXACTLY DOES NUTRITION BEING TO THE TABLE REGARDING WOUND HEALING?
The nutrients present in you are the Lego bricks used by the body to put together the complex structure that is your skin. They are divided in two; the macronutrients and the micronutrients. The former include proteins, carbohydrates and fats whereas the latter include a multitude of vitamins and minerals and trace elements.
Proteins: Proteins are the very bricks used in the construction of the wall that is the skin. Throughout the stages of wound healing, it is mainly proteins at work. From haemostasis, inflammation to proliferation and reorganisation of the new tissue, it is proteins at work. The growth factors and cytokines are proteins. The same applies to the fibrin used to clot and the collagen deposited to recreate the extracellular matrix. Proteins!
Carbohydrates: Every cellular process in the body requires energy to take place and carbohydrates are the source. In wound healing in particular, energy from carbohydrates is especially required during the fibroblast proliferation stage. If you recall, fibroblasts take charge of the formation of the new extracellular matrix as well as calling on macrophages and neutrophils via chemotaxis.
Fats: Fats are also a source of energy needed for high metabolic activity. Wound healing definitely qualifies as one of such bodily activities. Apart from being a source of energy, fats are also need in the creation of the dermal layers, and cell walls many of which contain a considerable amount of fat.
WHAT MICRONUTRIENTS PULL THEIR WEIGHT IN THE PROCESS OF WOUND HEALING?
Micronutrients are required in small doses in the body, but they do pack a punch regarding the work they do therein.
Some of the main ones include:
Vitamin B complex
Vitamin A, a fat soluble vitamin found mainly in vegetables, does a lot during the later stages of wound healing. It plays a big role in epithelial proliferation and well as maintenance of the collagen fibre that has been laid down. It inhibits various collagenases that break down collagen.
The vitamin B complex is found in dairy, meat, fish and vegetables. This set of 8 water soluble compounds mainly serves to promote cell proliferation as well as maintain muscle tone whilst increasing immunity.
Thiamine, a member of this set, is particularly essential. Lack of it results in decreased wound healing.
Vitamin C is a cofactor in the synthesis of collagen and also helps in the uptake and metabolism of other nutrients like iron. Speaking of, iron is vital in the formation of haemoglobin; the compound that carries oxygen to the tissues. In the hypoxic environment that is the wound bed, oxygen is needed to facilitate the healing process.
WHY IS NUTRITION IMPORTANT IN THE HEALING OF SEVERE WOUNDS?
Severe wounds like burns are usually chronic and therefore take on the secondary form of healing. This means that the wound edges cannot be closed and the healing process will take longer than normal.
In such instances, the patient has to be nutritionally robust, providing the body will all that it needs in order to carry out the repair. A study dealing with the wound healing response also noted that it is also important to focus on the food intake just before a surgical procedure because this provides the required energy for the healing process.
Apart from the nutritional requirements, the body needs plenty of energy to go on with this work. It is for this reason, therefore, that severe burn patients can lose weight as the body draws on its reserves. If this resting energy expenditure exceeds its value by 1.2 times, chances are the patient will not survive. High protein and high energy diets immediately after admission should try to offset this catabolic imbalance.
Kaimal S, Thappa DM. Diet in dermatology: Revisited. Indian J Dermatol Venereol Leprol 2010;76:103-15.
Hart, D. W., Wolf, S. E., Herndon, D. N., Chinkes, D. L., Lal, S. O., Obeng, M. K., … Mlcak RT, R. P. (2002). Energy Expenditure and Caloric Balance After Burn: Increased Feeding Leads to Fat Rather Than Lean Mass Accretion. Annals of Surgery, 235(1), 152–161.
Windsor, J. A., Knight, G. S., & Hill, G. L. (1988). Wound healing response in surgical patients: recent food intake is more important than nutritional status. British Journal of Surgery, 75(2), 135-137.
Alvarez OM, Gillbreath RI. Thiamine influence on collagen during granulation of skin wounds. J Surg Res 1982;32:24-31.
A product that is water proof, smudge proof, lasts for several days with customised colours to suit every skin tone, Microskin is changing lives of people across the world.
It started with makeup
Linda Lowndes was working in special effects makeup when an idea sparked to create a flexible simulated skin to cover skin conditions such as vitiligo, birthmarks, burns, eczema, lupus and keloid scarring. After years of research and development Microskin was launched in Brisbane, Australia in 2005.
Microskin now has clinics in the United States, Southeast Asia, the Middle East, Europe, New Zealand, Turkey, India and Pakistan and has helped hundreds of thousands of people across the world to improve their confidence and help them face the world.
Hear Julie Buckley of Microskin share how the product works, the application process and why it’s unlike anything else on the market. Listen here or search for the Dermhealthco Podcast on any platform you stream your podcasts from.
The before and after images speak for themselves
If you would like to learn more about Microskin visit the website.