The modified Patient and Observer Scar Assessment Scale: a novel approach to defining pathologic and nonpathologic scarring

Abstract

Background: Scarring is a highly prevalent and multifactorial process, yet no studies to date have attempted to distinguish pathologic from nonpathologic scarring.

Methods: This article defines and proposes methods of classifying pathologic scarring as it pertains to clinical presentation.

Results: The authors propose a new scar scale that incorporates pain and functional impairment.

Conclusions: The modified Patient and Observer Scar Assessment Scale is the first of its kind to factor in the functional deficits pain and pruritus of scarring into measurements of associated morbidity. This scale has great potential in evaluating patient response to treatment and analyzing clinical outcomes.

Conflict of interest statement

The authors have no financial interests.

Figures

Figure 1

Three different scars are presented to illustrate the wide variety of scarring: (A) scarred neck with contractures, (B) large total body surface area scar that is heterogeneous with contracture, and (C) a linear scar. Existing scar scales are useful to evaluate (C) linear scarring but not (A) functionally debilitating scarring or (B) large total body surface area scars.

Figure 2

The Patient and Observer Scar Assessment Scale (POSAS) was used as a basis for creating The Modified POSAS Pathologic Scar Scale. The modified scale now assesses the impact of pain and pruritus on activities of daily living. It also determines whether scarring affects function. If the pain or pruritus are reported to limit daily activities (darkened rows with “*” under “Patient Component”), then the impairment can be further assessed using the Pain and Impairment Relationship Scale. If scarring affects function (darkened rows with “**” titled “Function Assessment”), then the severity of the dysfunction can be determined by quantifying joint range of motion.

Figure 3

An assessment algorithm for scars that interfere with activities of daily living (ADL).