Scar Treatment Variations by Skin Type

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Key points

  • Patients and clinicians use skin color attributes such as color uniformity, color distribution, and texture to infer physiologic health status.

  • Normalization of skin color, surface texture, and height are important treatment goals.

  • Skin color, structure, function response to trauma, and scar formation vary with ethnicity.

  • The incidence of hypertrophic and keloid scar formation is influenced by these inherent variations.

  • Skin type influences the response to various modalities including laser therapy

Skin color

Clinical judgments of scar progression and treatment effectiveness depend on perception of the skin surface.3 Humans use skin color attributes such as color uniformity, color distribution, and texture to infer physiologic health status.4, 5, 6, 7, 8 In one study, subjects were asked to adjust the red color of high-resolution facial images to achieve a “healthy appearance”. All of them increased the red color, regardless of the inherent pigmentation, but dark skin subjects increased the red

Skin structure, function, color, and ethnic diversity

Skin color is commonly described by 2 systems:

  • 1.

    Fitzpatrick skin type

  • 2.

    Von Luschan skin coloration

The Fitzpatrick skin type system has 6 classifications based on inherent color and the response to ultraviolet radiation.17 An anthropologist, Fredrick Von Luschan, described skin coloration in the late 1900s.18 Fig. 1, and Table 1 compare these systems in relation to skin color.

Melanin, water, hemoglobin, and other chromophores absorb the incident light to varying extents, depending on the wavelength.

Scars and skin type

Tissue injuries can result in significant inflammation including increases in cells eg, neutrophils, macrophages, monocytes, growth factors, and cytokines that stimulate fibroblast migration and proliferation, excessive collagen and extracellular matrix deposition culminating in the formation of a hypertrophic scar.29 These scars have fine, well-organized type III collagen bundles, containing fibroblasts, numerous myofibroblasts, endothelial cells, and a higher density of microvesssels.30, 31,

Scar management

Optimization of coloration is an important goal of scar treatment.41, 42 Multiple modalities have been used for scar management, including glucocorticoid injections, retinoic acid, application of silicone gels, pressure garments, and simple massage.43, 44, 45, 46, 47, 48 Application of intense pulsed light (IPL), photothermolysis with pulsed dye laser (PDL), and ablation with a fractional CO2 laser are used to normalize scar color, size, and pliability.49, 50 In randomized within-subject

Managing the elusive keloid

Presently, the treatment management of keloids remains challenging and elusive. Surgical excision with primary closure, followed by local steroid injection is the mainstay of treatment (Box 1). However, the optimal treatment of keloids on the head and neck remains controversial. Factors to consider for keloid treatment are the site and size of the lesion, keloid duration, recurrence, and previous therapy. Combined therapy using surgical excision, post-operative steroid injection, and silicone

Stratum corneum and epidermis

Although the major target for scar therapy is the dermis, topically applied treatments are also used, particularly when the more superficial features require modification and/or when scar therapies result, for example, in hyper or hypopigmentation. The influence of inherent skin color on SC and epidermal structure and function is provided.

The literature on the effects of ethnicity on SC barrier integrity, measured as transepidermal water loss (TEWL), is variable. Two studies showed no

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    Funding Sources: None.

    Conflict of Interest: None.

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