After injuries, most of wounds leave scars. There are different types of scars too and in this page I would elaborate in specific scar types: hypertrophic, keloid and stretch mark scars. 

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HYPERTROPHIC SCAR

Hypertrophic scar is a common type of scar, usually slightly raised, no associated with skin colour and no familial predisposition. This type of scar remain within original wound borders and the size typically less than 1cm thick / wide. Although the onset within 4 weeks, however, it can grow intensely for months, then regress spontaneously less than a year. Hypertrophic scar mostly associated with contracture scar, with no predominant anatomical site on the body. It can also associated with acne scars. 

Hypertrophic scar can be minimise with skin needling treatment. The mechanism of action for skin needling in treating hypertrophic scar is to breaks down the scar tissue, activates cellular enzymes known as matrix metalloproteinases (MMP's)  and remodels scar tissue through proper deposition of collagen and elastin (Barone et al., 2021; Juhasz & Cohen, 2020). 

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KELOID SCAR

Keloid scar has low incidence, although very common with darker skin and mostly associated by genetic inherited. Keloid scar is scar growth beyond the original wound borders with variables sizes from pea to football. The onset of keloid scar is within several months, with continues growth indefinitely and do not regress spontaneously. No contracture associated. Often located on the chest, shoulder, upper back, back of the neck and earlobes. Keloid scar usually looks shiny and might have 'butterfly' pattern-like (Barone et al., 2021; Ekstein et al., 2021). 

Although skin needling may help to reduces the keloid scar, however, keloids should appropriately treated by medical practitioners and / or cosmetic dermatologists. 

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STRETCH MARK SCAR

Stretch marks can be caused by over-extension or excessive stretched of the skin. Can be found on men but more frequent on women. Stretch marks tend to start as red discolouration and later becoming a mature atrophic white stretch marks (Schuck et al., 2020). 

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Skin needling can help to minimise the appearance of stretch marks (Lu et al., 2020; Ross et al., 2017). The mechanism of action from skin needling for stretch marks are:

• Promotes the removal of old damaged collagen

• Stimulates keratinocytes proliferation that releases growth factors to encourage collagen deposition by the fibroblasts and elastin deposition

• Modulates expression of several genes in the skin such as vascular endothelial growth factor, fibroblast growth factor, epidermal growth factor, collagen type I and III, that promote extracellular matrix remodelling. 

We recommended minimum 6 treatments to see improvements in the skin with 2 to 4 weeks intervals. 

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Another treatment great to combine with skin needling to treat stretch marks is TCA peel (Mitra et al., 2021; Ross et al., 2017).

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REFERENCES

 

Barone, N., Safran, T., Vorstenbosch, J., Davison, P. G., Cugno, S., & Murphy, A. M. (2021). Current Advances in Hypertrophic Scar and Keloid Management. Seminars in plastic surgery, 35(3), 145-152. doi:https://doi.org/10.1055/s-0041-1731461

 

Ekstein, S. F., Wyles, S. P., Moran, S. L., & Meves, A. (2021). Keloids: a review of therapeutic management. International journal of dermatology, 60(6), 661-671. doi:https://doi.org/10.1111/ijd.15159

 

Juhasz, M., & Cohen, J. L. (2020). Microneedling for the Treatment of Scars: An Update for Clinicians. Clinical, cosmetic and investigational dermatology, 13, 997-1003. doi:https://doi.org/10.2147/CCID.S267192

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Lu, H., Guo, J., Hong, X., Chen, A., Zhang, X., & Shen, S. (2020). Comparative effectiveness of different therapies for treating striae distensae: A systematic review and network meta-analysis. Medicine, 99(39), e22256. doi:https://doi.org/10.1097/MD.0000000000022256

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Mitra, D., Singh, G. K., Singh, T., & Mitra, B. (2021). Use of 27-gauge Tuberculin Syringe for Trichloroacetic Acid Chemical Reconstruction of Skin Scars (TCA-CROSS). Journal of cutaneous and aesthetic surgery, 14(3), 357-358. doi:https://doi.org/10.4103/JCAS.JCAS_147_20

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Ross, N. A., Ho, D., Fisher, J., Mamalis, A., Heilman, E., Saedi, N., & Jagdeo, J. (2017). Striae Distensae: Preventative and Therapeutic Modalities to Improve Aesthetic Appearance. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.], 43(5), 635-648. doi:https://doi.org/10.1097/DSS.0000000000001079

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Schuck, D. C., de Carvalho, C. M., Sousa, M., Favero, P. P., Martin, A. A., Lorencini, M., & Brohem, C. A. (2020). Unraveling the molecular and cellular mechanisms of stretch marks. Journal of cosmetic dermatology, 19(1), 190-198. doi:https://doi.org/10.1111/jocd.12974

 

West, L., He, B., Vandergriff, T., & Goff, H. (2021). The Use of Microneedling to Treat Striae Distensae. Dermatologic Surgery, 47(10), 1407-1408. doi:https://doi.org/10.1097/DSS.0000000000003151

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