How does the skin’s healing mechanism work?
The skin insulates and protects the body from the external environment. When the skin is wounded, the body automatically activates a natural biological phenomenon: healing.
It is a complex restorative process during which the body needs to stop the bleeding and protect, cleanse and close the wound. The injured tissue has to be rebuilt to resemble the initial tissue as closely as possible.
Stages of Healing
Healing will trigger a series of stages to repair the injury. It comprises 3 successive phases, which are characterized by specific cellular activities that divide the repair process into precise overlapping chronological sequences. Each stage counts.
Stage 1: Priming (lasts two to four days)
First, a blood clot forms to help stop bleeding. Then, very quickly, the body will prepare itself to fight infection and defend itself against microbes and foreign bodies. The damaged tissues are destroyed thanks to special cells that absorb them. The blood capillaries are more permeable and promote the movement of blood plasma and immune cells (e.g. antibodies) to the traumatized region.
Stage 2: Repairing (lasts 10 to 15 days)
The small vessels that were injured during the skin trauma will gradually rebuild themselves. The body starts to fill in the lost substance with a new tissue by synthesizing the collagen fibres with fibroblasts.
An epithelium forms on the uppermost layer of the skin. At the same time, the wound will shrink, allowing the edges of the wound to move together until the wound closes completely. Numerous cells and molecules are activated. This stage is important to prevent aesthetic damage, keeping in mind that we do not all heal equally. The darker the skin and the younger we are, the higher the risk of a visible scar. Moreover, healing is less effective on some body parts, including the chest, sternum, back and joints.
Stage 3: Maturing (lasts two months to two years)
During this stage collagen and elastin fibres will become denser and grow to structure the skin. The vascular bed will also prepare to return to a "normal" state. As a result, the skin’s resistance will increase, and so will its elasticity, allowing it to be firmer. The healed area remains fragile for two years while the skin is restored to its initial balance.
What are the different types of lesions?
Lesions can be classified based on their biological and clinical characteristics: how much moisture/nutrition they need and how much occlusion they need. There are three classes of lesions:
Oozing lesions: lesions subject to maceration that need to be dried out with a non-occlusive product that allows air to reach wound
- Nappy rash,
- Skin fold maceration,
- Chicken pox with oozing lesions, and
Non-oozing lesions: superficial to moderate lesions that need moisture from a semi-occlusive product that is breathable
- After a surgical procedure (e.g. sutures);
- Cuts, scrapes and other everyday injuries after wound has dried;
- Chicken pox in the healing phase;
- After a cosmetic procedure (e.g. peel, laser treatment, permanent hair removal, tattoo and tattoo removal);
- Non-oozing nappy rash; and
- Radiation therapy.
Non-oozing lesions: moderate to major lesions that require lipid replenishing nutrition from an occlusive product that forms a barrier
- Chapping, dry patches, pulpitis, etc.;
- Scratching; and
- Abrasive laser treatments.
What factors play a role in the healing process?
First of all, it is essential to take into account the topography of the scar. Some areas of the body don’t heal as well as others.
For example, there is a risk that the edges of a wound located on the back or chest will separate, causing an increased risk of hypertrophic or keloid scarring.
Wounds on the knees or ankles require a lot of time to heal. It is critical to carefully monitor them and take care of them on a regular basis to promote proper healing.
Genetics also play a very significant role. You should always refer to past scars to assess risks of improper healing. Keep in mind that the healing process is not over once the scar has closed. Healing is a matter of months and varies from one individual to another.
How can I promote proper healing?
Once the scar has closed, you will want to take some precautions for several months. Depending on where the scar is located on the body, you should take care not to put too much pressure on it (for example, don’t carry heavy things if the scar is on your back) because this increases the risk that the edges will separate, causing suture disunion.
The scar should evolve as naturally as possible, but some products can limit scabs, itching and pain, which impact healing quality.
Lastly, you absolutely must choose optimum an photoprotection product with a high protection factor and apply it frequently to achieve lasting anti-UV ray protection. Damaged skin that is exposed to UV rays is more likely to have post-scarring hyperpigmentation. Protecting yourself is not just important in the summer; UV rays are bombarding you throughout the year, even through clouds, windows, windshields and more. The risk of scar hyperpigmentation usually lasts six months, but can continue for up to two years. Only a doctor can evaluate whether the risk has diminished.
What are the signs of improper healing?
Some people have a tendency to experience difficult healing. A hypertrophic scar is an active scar that swells up six weeks to three months after the procedure and becomes red. It may slowly progress into a keloid. There are also cases of abnormal healing where cellular and vascular flows continue developing next to the clot.
In all cases, you should have your scar checked within three months following the procedure and see a health professional if it swells up or becomes red.