Daily Quality-of-Life Impact of Scars: An Interview-Based Foundational Study of Patient-Reported Themes

Given the negative psychological effects of scarring, it is a pressing issue for wound healing clinicians. Effective scar scales necessitate patient interview data, otherwise scale items reflect what measures clinicians deem appropriate, not patients. Available scar scales are lacking: A 2016 review by Mundy et al. reported four major scar-specific scales with a measure of quality of life—POSAS, PSAQ, PRISM, and Bock Quality of Life Questionnaire—and found that as each scale had unique limitations, there is no scale designed using patient interview data with measures of both appearance and symptoms. Klassen et al.’s Scar-Q attempts to address these concerns, utilizing patient interviews to draw common patient “themes” in scar appearance, psychosocial effects, and symptoms. There remains a need to study themes in sexual well-being and career advancement, two areas that scarring affect.

Our qualitative interview study interviewed 37 patients, 9 (24%) male and 28 (76%) female, with keloid (5%), hypertrophic (14%), atrophic (11%), and linear (49%) scars primarily of surgical (68%) etiology. Most patients (41%) reported a “moderate” level of scar impact followed by a “low” level (30%). Most subjects (46%) were Caucasian, followed by African American (27%). The study protocol was submitted to and accepted by the Northwestern University IRB.

Themes were organized into eight domains. Domains such as psychosocial effects remained dominant, with themes such as “commonly thinking about a scar” referenced 56 times by 26 patients. Patients did reference themes that organized under sexual well-being and career. Impact of scarring on workplace interactions and networking was referenced five times by three patients, and feelings of insecurity specifically during intimacy was referenced 13 times by seven patients. While perhaps not as prevalent as psychosocial effects, effects of scarring on career and sexual well-being remain present, and a comprehensive scar scale should touch upon these domains.