Scar Themes: A Qualitative Interview Study of Patient Quality of Life After Scarring

Background: 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.

Purpose: There remains a need to study themes in sexual well-being and career advancement, two areas that scarring affect. 

Methods: 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.

Results: Themes were organized into 8 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 5 times by 3 patients, and feelings of insecurity specifically during intimacy was referenced 13 times by 7 patients.

Conclusion: While perhaps not as prevalent as psychosocial effects, effects of scarring on career and sexual-wellbeing remain present, and a comprehensive scar scale should touch upon these domains.