Scars are described as fibrous tissue areas that replace normal skin after destruction of some of the dermis.

Scars are a change in the skin secondary to trauma or inflammation. Scars may be erythematous, hypopigmented, or hyperpigmented depending on their age or character. Scars on hair-bearing areas may be characterized by destruction of hair follicles.

Causes include burns, surgical operations, lacerations or, less commonly, diseases including skin diseases.

Scars can limit motion. Initially, a scar is red or purple and, in time, becomes pale, fibrous and glistens. Abnormal scars include, but are not limited to the following types:

• Keloid scars are shiny, hard and raised scar with an overproduction of scar tissue due to abnormal amounts of collagen deposit. It may be tender and cause contractures.

• Contracture scars result in loss of a large area of skin that may pull the edges of the skin together causing a contraction. This type of scar may affect the underlying muscles and tendons and restrict movement.

• Hypertrophic scars are similar to keloid scars since both are thick, red and raised. They remain within the boundaries of the original wound and improve on their own usually over the course of a year or so. Healing is helped by applying topical steroids or injections of steroids.

• Acne scars cause the skin to create deep pits or to appear angular or wavelike.

Physical examination alone is adequate to diagnose many skin disorders, e.g., scars. However, if the underlying cause for the scar or scars is a disease or burn, further diagnostic studies may have to be conducted. These additional studies may include: microscopic examinations, culture and sensitivity (C&S) tests.

Topical applications of antihistamines and/or steroid creams may reduce redness and itching. Steroid injections or other fillers such as collagen may be used to smooth pitted scars. Deeper scars such as contractures may require skin grafts / flaps, excision, dermabrasion or laser surgery.

Scars may prevent normal joint mobility and limit function. Furthermore, scars can be disfiguring and promote body image disturbances which may require follow-up counseling.

• Evaluate any disabling effects, not considered in a rating provided under the diagnostic codes 7800-7804, under an appropriate diagnostic code.

• To properly evaluate disability, accurate measurements of scar size/area, and limitations in motion (if applicable), must be available.

• In questionable or severe cases, unretouched color photographs can be helpful in determining extent or severity of disfigurement.