Skin Healing - When Skin Heals by Itself

The skin heals itself in a variety of different ways according to the problem.

Following injury, the skin needs to seal off any broken blood vessels and fill up the hole created in the surface of the skin so that blood, lymph and other vital bodily substances are not lost. A small plug occurs first, which dries and then forms a hard shield. This is known as a scab. The scab serves a second purpose of acting as a cover to prevent entry of bacteria, dirt and other toxic or irritant substances through the injury into the skin.

The scab also forms a cover under which the underlying skin can get on with the healing process. This includes repairing the damage to the fibre structures deep in the skin and also replacing the cellular layer over the top. Once that healing process is complete, the scab will fall off leaving normal skin underneath.

If the injury to the skin is extensive, particularly if it affects the deeper layer of the skin, the healing process requires laying down of new collagen which produces a scar. If the injury only involves the surface layer of the skin, then no collagen is required and no scar forms.

Occasionally, healing can produce more tissue than is necessary merely to fill in the hole from the injury. The scar then becomes thickened, raised or may even spread out from the original site of injury. This is known as a keloid scar. Keloid scars tend to occur more often in some areas than others. They commonly occur on the upper chest and back, the upper arms and occasionally the neck.

Healing following common skin conditions

1. Acne

If the acne pustule only involves the outer layer of the skin, then the healing involves reducing the inflammation associated with the pustule. Eventually the skin will return completely to normal. Occasionally, following a pimple there can be a slight increase in skin colour as part of the healing process. This is called post inflammatory pigmentation. It may take 3-6 months before the skin colour returns to normal.

If there is extensive damage to the deeper layer of the skin as a result of a large pimple, i.e. a nodule or a cyst, then the repair process requires the production of collagen and consequently the formation of a scar. On the face, the scars can be raised, or on occasion may leave small holes, i.e. pits. As mentioned above, if the scarring acne occurs on the chest, then there may be the production of keloid scars. The scars are initially red and raised and may be itchy. Eventually, they fade back to the colour of normal skin and will flatten out over a number of years. But they always remain.

2. Eczema

Eczema is an inflammatory process with most changes mainly confined to the outer layer of the skin with some inflammatory cells in the deeper layer. As described above, if damage is occurring mainly in the outer layer, when healing occurs no scarring remains.

Healing in eczema requires reduction of the inflammation, removal of the inflammatory cells and removal of the tissue fluid which is associated with the inflammation. Occasionally, following the inflammation of eczema, there may be some post inflammatory pigmentation (increase in skin colour). This will eventually clear in 3-6 months. On other occasions, the inflammation can lead to a loss of colour in the skin and the skin will appear pale in some areas. This is called post inflammatory depigmentation. The colour gradually returns to the skin over a period of 3-6 months, at which stage the skin looks completely normal.

3. Tinea Tinea, or ringworm, is an infection of the outer layer of the skin caused by a fungus. The body reacts to this by creating inflammation and shedding skin. Occasionally blistering and fluid accumulation occurs.

The healing process involves reducing the inflammation, removing the accumulated fluid and also reducing the shedding of cells from the skin. As the condition is predominantly occurring within the outer layer of the skin, no scarring remains when tinea eventually clears and healing has occurred.

When the fungus infects the nails, the healing required there is more difficult. The immune system has difficulty getting into the nail to remove the fungus. If an antifungal treatment is used which kills the fungus, then it requires time for the infected nail to grow out and the abnormal area to be completely removed. Tinea of the nail does not cause permanent nail damage.

4. Warts

Warts are viral infections affecting the outer layer of the skin. An overgrowth of the cells and inflammation occurs. Healing involves the immune system recognising that the virus is growing in the cells and killing it. The infected cells die and are then replaced by growth of other cells. Because the condition occurs in the outer layer of the skin, once the condition has cleared the skin will return to normal and no scarring will occur. This is important to remember when considering the use of some treatments for warts that might lead to scarring.

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