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Updated: Mar 3, 2026
Visualizing Scar Development Using SCAD Assay - An Ex-situ Skin Scarring Assay
Published on: April 28, 2022
Investigating histological aspects of scars in children
I Westra1, P D H M Verhaegen1, H Ibrahim Korkmaz2
1Department of Plastic, Reconstructive and Hand Surgery, VU Medical Centre, Amsterdam, the Netherlands.
Insights
Paediatric scars exhibit random collagen fiber orientation, unlike adult scars. Children with acute lymphoblastic leukemia (ALL) showed less severe scarring, suggesting the immune system influences scar development.
Area of Science:
- Dermatology
- Oncology
- Immunology
Background:
- Paediatric scar histology and the immune system's role are poorly understood.
- Central venous access device placement in children undergoing cancer treatment creates thoracic scars.
Purpose of the Study:
- To investigate histological aspects of paediatric thoracic scars.
- To explore the potential role of the immune system in paediatric scar formation and severity.
Main Methods:
- Histological analysis of collagen, elastic fibers, and vascularization.
- Quantification of immune cells (neutrophils, macrophages, lymphocytes).
- Assessment of scar severity using the Vancouver Scar Scale (VSS).
- Comparison of scars between children with acute lymphoblastic leukemia (ALL) and other childhood cancers.
Main Results:
- Paediatric scars showed significantly random collagen fiber orientation (mean index 0.22).
- Lower collagen orientation index correlated with lower VSS scores.
- Scars in non-ALL cancer patients were more severe (mean VSS 2.50) than in ALL patients (mean VSS 0.91).
Conclusions:
- Paediatric scars have a distinct, highly random collagen orientation compared to adult scars.
- Immune system modulation may influence paediatric scar severity.
- The immune system is a potential target for future research in aberrant scarring.
Objective:
Very little is known about histological aspects of paediatric scars and the possible role of the immune system during their formation. In this study, the histology thoracic scars caused by the placement of an implantable central venous access device in children who underwent treatment for cancer was assessed.
Method:
The amount and type of collagen, the collagen orientation, the type of elastic fibres, the vascularsation, and the count of neutrophils, macrophages, and lymphocytes were analysed. The severity of scarring was assessed using the Vancouver scar scale (VSS). To evaluate the role of the immune system on scar severity and histology, the scars of children suffering from acute lymphoblastic leukaemia (ALL) were compared with the scars of children suffering from other types of childhood cancer.
Results:
Our results showed an extremely random orientation of the collagen fibres of the paediatric scars with a mean collagen orientation index of 0.22 (standard deviation (SD) 0.10, zero indicating a perfectly random orientation and a perfectly parallel orientation). A lower collagen orientation index was seen in scars with a lower VSS score (VSS score <3: 0.19 versus VSS score ≥3 0.29, p=0.037). A higher total VSS score, resembling a worse scar, was assessed to the scars in the non-ALL group compared with the children with ALL (mean ALL: 0.91 (0-3) versus mean non-ALL: 2.50 (0-6), p=0.037).
Conclusion:
To our knowledge, this is the first study investigating a wide array of histological aspects in paediatric scars. Compared with adult scars, an extremely random collagen orientation was found (0.22 in children versus 0.41 and 0.46 adult normotrophic and hypertrophic scars, respectively). A lower collagen orientation index was found in scars with a lower VSS score. In addition, less severe scarring was measured in children suffering from ALL compared with children suffering from other types of childhood cancer. This suggests that the immune system could play a role in the development of aberrant scarring and should be a target for future research.
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