What influences scar formation?

The risk of developing abnormal scars depends on the age of the patient, the location of the scar, genetic factors (such as skin type) and complications arising from exposure to wound infections:

Age
Keloids tend to develop most likely between the ages of 10 and 30 years.^1,2,3 Also younger people are more frequently subjected to trauma.²
With aging, the skin healing process takes more time, due to the loss of elasticity, while younger skin tends to “overheal” forming larger, thicker scars.²

Genetic factors – skin type
Patients with darker pigmented skin are prone to abnormal scars, particularly keloids.^1,2,3 Higher risks also appear to people with ginger hair and freckles and to those with previous pathological scarring⁴ or with a family history of such scarring.

Hormonal influences
Larger scars tend to develop during pregancy and puberty.^1,2

Scar location
Scars over or near muscles that are particularly active, such as the chest, back, legs, shoulders (e.g. deltoid muscles) and joints, often spread or become more visible than scars formed on less active areas.² Earlobes, shoulders and presternal skin have a high likelihood of developing keloids.²

Wound infection or complications
Wound infection increases the likelihood of abnormal scarring. Some surgical procedures have an increased risk of such scarring (e.g. breast surgery etc.)⁴

• 1. Brissett AE, Sherris DA, Facial Plast Surg 2001; 17:4
• 2. English RS, Shenefelt PD, Dermatol Surg 1999; 25:631-638
• 3. Bayat A et al., BMJ 2003; 326:88–92
• 4. Mustoe TA et al., Plast Reconstr Surg 2002; 110:560–571