**7. Scars**

A scar refers to a growth of tissue marking the spot where skin has healed after an injury. And while scars are used for body modification and 'body art' in some cultures, most take it to be a sign of someone surviving a catastrophic event or a debilitating disease [2, 3]. They are predominantly of two types:

**Keloid scar:** these are scars that have overgrown their boundaries with large collagen bundles in their midst and being limited in macrophage content but abundant in eosinophils, mast cells, plasma cells and lymphocytes [90–92].

**Hypertrophic scar:** Hypertrophic scars do not have collagen bundles, but nodules of α-smooth muscle actin–staining myofibroblasts that contain cells and collagen [93].

#### **7.1 Treatment**

While multiple treatments are promoted/suggested to minimise the development of scars, none have been proven to be completely effective. Keloid scars especially are difficult to treat because of their high recurrence rate.

Common scar-treatment modalities include:

**Excision:** While one of the more popular treatments, excision alone (especially in the case of keloid scars) has been proven to have a high recurrence rate ranging from 45 to 93 percent.

However, when coupled with other treatment practices, excision has been known to lower recurrence risk [90–92].

**Laser excision:** Lasers cause a range of specific thermal tissue reactions in a dry and bloodless environment and was initially utilised in the hopes of reducing scar formation, however they are not frequently used in the present date owing to their high recurrence levels [94, 95].

**Radiation Therapy:** Radiations have been used in the eradication of this benign lesion since the 1960s; however current concerns regarding the safety of patients due to increased risks of developing skin cancer; have limited the perpetuity of this therapeutic modality [94].

**Steroids:** While steroids themselves are known to interfere with wound healing, they are used in initial treatment of scars as they suppress the inflammatory stage [95, 96].

**Cryo-surgery:** Traditionally, cryotherapy have been used for managing hypertrophic scars and keloids, with pre-treatment and post-treatment histological analyses indicating significant improvement in scar organisation after needle cryosurgery [93].

**Interferon:** IFN-α-2b normalises the collagen and glycosaminoglycan of the keloid, thereby interfering with the fibroblasts collagen synthesis [97]. Complications with IFN-α-2b include flu-like symptoms, headache, fever, and myalgias.

However, till date; prevention is the best keloid therapy.
