Observations on the procedural aspects and health effects of scarification in sub-Saharan Africa.
BACKGROUND
Scarification involves cutting or making an incision into the skin and then allowing the wound to heal, leaving a permanent scar. The purpose of this article is to examine the origins of scarification and its social and medical significance in sub-Saharan Africa.


METHODS
We conducted a computerized search in the MEDLINE electronic database with combinations of the following terms: scarification, tribal marks, keloid, hypertrophic scar, Africa, and sub-Saharan Africa. Inclusion criteria were studies published in English involving human participants. We reviewed the bibliography of each article that met our inclusion criteria for additional relevant studies. We abstracted data on the historical, social, and medical aspects of scarification from eligible studies.


RESULTS
This review of scarification in sub-Saharan Africa highlights the complex interplay that exists between biology and society. Photographs, artwork, and literary descriptions reveal that scarification results in hypertrophic or atrophic scars, although these types of scars are often mistakenly referred to as keloids. In terms of the procedural aspects of scarification, specific tools and substances were consistently used by various ethnic groups. Although much is known about the history of scarification as a form of identification in Africa, it appears that the practice also had medical applications. Scarification was used to treat conditions such as epilepsy, although it was also known to exacerbate conditions such as sarcoidosis, lichen planus, and psoriasis. Evolving cultural beliefs, in addition to the association of scarification with an increased risk of contracting hepatitis B and human immunodeficiency virus (HIV), are contemporary threats to this long-standing practice.


CONCLUSIONS
Given the remarkably consistent appearance of scars that are described in the literature and depicted in images, scarification does not appear to be a random or accidental occurrence. Instead, it is a deliberate attempt to reproduce a custom that has been perfected after many years of practice in sub-Saharan Africa.
Department of Plastic Surgery, McMaster Medical Centre, Hamilton, ON, Canada. oayeni@lakeheadu.ca
Olubimpe A
OA
Ayeni
Olubukunola O
OO
Ayeni
Robert
R
Jackson
D017954:Africa South of the Sahara / Q000208:ethnology; D002921:Cicatrix / Q000150:complications / Q000208:ethnology* / Q000523:psychology; D003469:Culture; D005006:Ethnicity / Q000208:ethnology* / Q000523:psychology; D006801:Humans