What is a normal scar called?

Normal Scar Types and Classification

A normal scar is called a normotrophic scar or mature scar, which is flat, non-elevated, and typically matches the surrounding skin color or appears slightly lighter. This type of scar represents the ideal outcome of the natural wound healing process.

Types of Scars

Scars can be classified into several distinct categories based on their appearance and characteristics:

1. Normotrophic/Mature Scar

   • Flat and level with surrounding skin
   • Minimal width
   • Color similar to surrounding skin or slightly lighter
   • No functional impairment
   • Follows natural skin tension lines

2. Hypertrophic Scar

   • Raised above skin level
   • Confined to original wound boundaries
   • Often red or pink in color
   • May cause discomfort or itching 1

3. Keloid Scar

   • Extends beyond original wound boundaries
   • Continues to grow over time
   • Often painful and itchy
   • More common in darker skin types

4. Atrophic Scar

   • Depressed below surrounding skin
   • Common with acne or chicken pox
   • Often has a pitted appearance

S.C.A.R. Classification System

A more comprehensive classification system has been proposed that categorizes scars into four distinct endotypes 2:

• Stretched (flat) - Normotrophic scars that appear flat but may be wider than ideal
• Contracted - Scars that cause functional limitation due to contracture
• Atrophic - Depressed scars with loss of tissue
• Raised - Elevated scars including hypertrophic and keloid types

Characteristics of Normal Scars

Normal scars undergo a predictable maturation process:

• Initially appear red/pink due to increased vascularity
• Gradually fade to match surrounding skin over 6-18 months
• Become flatter and softer with time
• Achieve approximately 80% of normal skin strength 3
• Show organized collagen fiber arrangement compared to the disorganized pattern in hypertrophic scars 4

Clinical Implications

When evaluating scars, clinicians should consider:

• Location - Scars in high-tension areas (shoulders, chest, knees) are more prone to abnormal scarring
• Patient factors - Age, genetics, skin type, and underlying conditions affect scar formation
• Wound characteristics - Clean surgical incisions typically form better scars than traumatic wounds

Management Considerations

For normotrophic scars that represent normal healing:

• Regular moisturization to maintain skin elasticity
• Sun protection to prevent hyperpigmentation
• Silicone sheets or gel may improve appearance in early stages
• Massage therapy may help with scar maturation

For abnormal scars requiring intervention, treatment should be based on the specific scar type and characteristics 5.

Understanding the difference between normal scarring and pathological scarring is essential for appropriate management and setting realistic expectations with patients regarding the natural healing process.