Keloid and hypertrophic scars are the result of an injury occurring deep within the skin tissue. Injuries that cause these scars include surgery, cuts, acne, chickenpox, and other trauma to the skin. These scars are the body's natural response to a wound and are characterized by raised lesions on the skin. A keloid scar extends beyond the original injury site and gets worse over time. The first instances of keloids were recorded on papyrus in ancient Egypt, describing the scar as a Òcrab's claw.Ó Alternatively, a hypertrophic scar does not extend beyond the original injury site. While a scar never completely heals, a hypertrophic scar typically flattens and improves in appearance over time.
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Hypertrophic and keloid scars are described to be a variation of typical healing. Typical wounds take between six and eight weeks to achieve a balance where the skin is 30-40% healthy. At this point, the scar develops and thickens. Over the months, this thick scar will usually fade and flatten into a white, leveled out mark. At this point, the scar is mature and will continue to fade over time. Alternatively, hypertrophic and keloid scars occur when there is an imbalance in this healing process. Instead of flattening, the skin produces an excess of collagen. This excess causes the scar to grow up and out above the skin instead of flattening. This scar remains elevated due to the excessive tissue produced.
During the beginning stages of the scar, it is often very difficult to distinguish the keloid from the hypertrophic scar. They both appear similar and are caused by the same overgrowth of tissue. As the scars mature, it is easier to differentiate the two lesions. Keloids contain collagen in wide, pink bundles that are not present in the hypertrophic.
Keloid and hypertrophic scars rarely result in severe symptoms but can often be painful, tender, and visually unappealing to the eye. The exact causes of these types of scars are still unknown but seem to have a link to genetics. Injury to the skin (surgery, wounds, acne, chickenpox) are the main surface cause to the development of keloids as well as the presence of infection or skin tension.
There is no way to know the type of scar or severity that an injury will bestow upon the skin, although keloids and hypertrophic scars occur on certain groups of people most often. Only humans are affected by these kinds of scars and they have their highest prevalence in those between the ages of 10-30. Newborns and the elderly are the least likely to contract a keloid scar.
Treatment for keloid and hypertrophic scars vary depending on the patient and type of scar. Prevention is key and can be practiced by avoiding unnecessary surgery in those prone to keloids, closing wounds with minimal tension, and ensuring that incisions follow skin creases. If a keloid still occurs, patients can elect to undergo therapy, surgery, injections, or medications. Each treatment plan will affect patients differently, vary in cost and time, and require proper follow-up care.
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