Scars - General Information

It is known how widespread are scars of the skin - an organ that performs various functions, but the main role of which is to protect the body from aggressive external influences that can disrupt homeostasis and harm the biological system. As a result of surgical interventions or other traumatic factors (mechanical, temperature, chemical, ionizing radiation, destructive skin pathology), the integrity of the skin is violated, in response to which general and local neuro-humoral mechanisms are activated, the purpose of which is to restore homeostasis.

When the integrity of the skin is damaged, the body reacts with a protective inflammatory reaction, resulting in the appearance of new tissue. Depending on the depth of the damage, the inflammatory process ends either with complete reparation of the normal skin structure or with the replacement of the defect with connective tissue. When destruction occurs below the papillary layer, the restoration of the integrity of the skin always occurs through the formation of a "patch" of coarse fibrous connective tissue - a scar. Dupuytren was the first to call this newly formed tissue cicatricial.

It is known that a scar is a secondary morphological element of the skin, which occurs as a result of pathophysiological processes. I.V. Davydovsky in 1952 called a scar a product of pathological tissue regeneration. However, academician A.M. Chernukh wrote in 1982: "An inflammatory reaction that leads to a result useful for the body should be classified as completely normal, adequate, and adequate inflammation is characterized as a protective reaction of the body. The result of such adequate inflammation are normal physiological scars. Inadequate inflammation does not limit itself, has a protracted course and ends with the formation of pathological scars."

O. Braun-Falco (1984) called a scar a permanent fibrosis as a result of skin damage, O.D. Myadelets, V.V. Shafranov. I.G. Korotkiy consider skin scars as a compensatory reaction of the body in the form of cellular regeneration and tissue hyperplasia. But no matter how doctors interpret scars, they are "patches" on the skin of a recovered person, who remains with them for the rest of his life.

Scars on the face, exposed areas of the body for young people, especially women - a big emotional drama. So. a very common disease of young people - acne. According to literature, in approximately 50% of cases it leaves behind hypotrophic scars of varying depth and size. It is impossible to apply makeup to skin with such scars or somehow camouflage them - their visibility is even enhanced. Teenagers suffering from such skin defects are often ridiculed by classmates. which leads to unwillingness to study, psychological breakdowns and even suicidal attempts.

The biggest problem is keloid scars, as they tend to grow scar tissue in all directions and bother patients not only with their unaesthetic appearance, but also with itching and paresthesia in the scar area. The problem of keloid scars is extremely relevant also due to the fact that the percentage of patients with keloid scars is steadily increasing. Thus, according to various authors, from 12% to 19% of all those who applied to medical institutions with scars suffer from keloid scars. Women account for about 85%. These people feel inferior, hence their complexes. mental instability.

A special contingent of patients with scars are those after plastic aesthetic surgeries. Patients undergo surgery to improve their appearance, but instead or along with it, often receive disfiguring scars. The occurrence of keloids after plastic surgeries is a particularly serious problem and psychological trauma not only for patients, but also for surgeons, since such scars practically nullify the fruits of their skill, sometimes causing litigation with patients.

The problem of skin scars is becoming increasingly important due to the fact that those who suffer from them are the youngest, most active and socially promising part of the population. Worried about their unaesthetic appearance, patients with scars withdraw into themselves; they retreat into their "problem", try to get treatment, not knowing exactly which specialists to contact. Most often, to improve the appearance of scars, patients contact doctors of three specialties - surgeons, dermatologists and cosmetologists. Extensive scars and cicatricial deformations - this pathology is related to the field of activity of plastic surgeons and it is impossible to improve the appearance of such scars without a scalpel. However, even after surgical correction, scars remain that bother the patient and can be improved by dermatocosmetological means and methods. Dermatologists practically do not deal with this problem, many cosmetologists do not want to mess with these patients, since the work required is long, diverse and the results are not very encouraging. Surgeons tell patients that they can no longer do anything or that this is not a surgical pathology at all. Thus, patients find themselves homeless, left to their own devices and in an endless search for a place or center that would help them. They turn to beauty salons or centers that advertise scar treatment or even "scar removal." Doctors understand that it is impossible to remove a scar from the skin so that normal healthy skin appears in its place, but patients hoping for a cure do not understand this. As a result, they waste time, money and... lose hope of getting an aesthetically acceptable appearance of their scars. In fact, with a systematic, strictly individualized approach to each patient and specifically to their cicatricial pathology, it is possible to help these people. Not removing the scar, but significantly improving its appearance is a very real task for any cicatricial pathology.

In order to determine the correct tactics for treating scars, it is very important for dermatologists, surgeons and dermatocosmetologists to be able to classify scars and conduct differential diagnostics between them, since depending on their clinical and morphological characteristics, the means, methods and technologies used change significantly, and, accordingly, the treatment results.

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