Scar L90.5

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Cicatrix; hypertrophic scar; Immature scar; Mature scar; Scar; Scars

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Connective tissue replacement of a loss of substance (ulcer). Final stage of wound healing.

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Scar classification according to Mustoe (varies here)

  • Mature scar (light, flat scar at skin level or slightly below skin level)
  • Immature scar (red, sometimes itchy and rarely slightly painful papules or plaque, minimally increased)
  • Linear hypertrophic scar (red, raised, sometimes itchy and slightly painful scar, growth 3-6 months, then regression over 2 years)
  • Flat hypertrophic scar (> 0.5 cm, red, irregularly raised, also nodular, distinct itching and pain to touch, occasionally also spontaneous pain; initial wound edges are respected)
  • Small keloid (red, irregular surface level, also nodular, always itching and highly sensitive to touch, spontaneous pain; initial wound edges are exceeded)
  • Large keloid (> 0.5 cm, red, irregular surface level, plaque-shaped also nodular, also irregularly bumpy, always itching and highly sensitive to touch, spontaneous pain frequent; continuous growth over 1 year. Initial wound edges are exceeded)
  • Atrophic scar: pale, often multiple skin depressions, also narrow deep (ice pick), or wide cup-shaped (rolling), or wide like punched out (boxcar) depressions

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  • Scars arise as a repair defect of the collagenous network of the reticular dermis and possibly also of the subcutaneous fatty tissue after trauma, through necrotizing inflammation or (rarely) through a malformation.
  • Scarring is observed, for example, in response to mechanical action, especially on pre-damaged skin (e.g. damage by corticosteroids [steroid skin] or senile involution). However, scars can also occur in inflammatory or infectious diseases if the disease process itself leads to the destruction of dermal connective tissue and/or the destruction of skin appendages. Typical examples of this are chronic discoid lupus erythematosus or lupus vulgaris.

Clinical features
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The epidermis in a scar appears thinned and folded like cigarette paper in its atrophic final state, the skin surface is flat or deeply sunken. A scarring of the fatty tissue is visible as a trough-shaped indentation. Scars are mechanically less resilient and also less tear-resistant.

In their final state they are lighter in colour than their surroundings (loss of melanocytes), less often hyperpigmented (dark-skinned people).

Occasionally, spatter-like or bizarrely linear pigmentation may occur in a scar surface. These usually start at the edge of the scar (in the case of persistent follicular structures, repigmentation in the centre of a scar can also start from these) and are to be seen as an attempt to repigment the pigment-less scar.

Hypertrophic scars or scar keloids present as rough exophytic papules, plaques or rough nodes.

Scars can also grow out as coarse connective tissue strands, which may lead to restrictions of movement that should be prevented as far as possible.

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Mature healed scar: Vessels and epidermis thickness are reduced in the area of the scar. The dermis usually shows an accumulation of fibroblasts of varying density, parallel to the surface. Inflammation parameters are missing. Skin field, follicle orifices, papillary relief, elastic fibres, hair and skin glands are reduced or missing completely.

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Scars are easy to identify by ophthalmological diagnosis and anamnesis. The scar structure and shape will be based on the pre-existing ulcer (loss of consistency).

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  1. Aschoff R (2014) Therapy of hypertrophic scars and keloids. Dermatologist 65: 1067-1077
  2. Mustoe TA et al (2005) International clinical recommendations on scar management. Plast Reconstr Surgery 110: 560-571


Please ask your physician for a reliable diagnosis. This website is only meant as a reference.


Last updated on: 29.10.2020