A NEW QUANTITATIVE SCALE FOR CLINICAL SCAR ASSESSMENT

Wound healing in adult human skin results in varying degrees of scar f ormation, ranging clinically fr om fine asymptomatic scars to problema tic hyper trophic and keloid scars, which may limit function and restr ict further growth. At present, no good objective method of clinically assessing scars exists, which is problematic for the evaluation of sc ar prevention or treatment regimens. Similarly lacking are histologic correlates of what we consider good and bad clinical scars. The object ive of this study was to quantitatively assess human scarring (1) clin ically, by developing a comprehensive rating scale, (2) photographical ly, using an image capture system and a scar assessment panel, and (3) by histologic analysis following scar excision. We assessed 69 scars, with a wide clinical range of severity, in patients who were undergoi ng surgery, for whatever reason, that involved removal of an old scar. Preoperatively, patients had their scars assessed, clinically using o ur newly developed scale and photographically using a computerized ima ge capture system. These photographs were then sent to a panel for ass essment using similar criteria to those used clinically. Assessment of scars from photographs correlated well with the clinical scar evaluat ion, indicating its potential utility in multicenter scar prevention/t reatment trials. Following excision, scars were processed and analyzed for histology. We also found a strong correlation between the macrosc opic and microscopic appearance of seals, particularly between the cli nical appearance and histologic scores of features in the epidermis an d papillary dermis. This suggests that our clinical scale is a sensiti ve instrument in scar assessment, allowing validated quantification of the severity of a wide range of scars.