In actuality, hypertrophic scars and keloids are two separate conditions. The definitions overlap, and both are caused by overgrowth of collagen in a healing incision. Keloid and hypertrophic scars represent an aberrant response to the wound healing process. Both are common and frequently disturb patients greatly, both as an unsightly scar as well as a reminder. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. A hypertrophic scar is similar but remains confined to the initial defect and tends. A new treatment of hypertrophic and keloid scars with. Pdf keloids and hypertrophic scars can now be treated.
This means that the scar response is appropriate given the degree of injury to the area. They dont get a big as keloids, and may fade with time. Pdf wound reparative process after surgery, burns, injuries, and. The authors have no financial interest to declare in relation to the content of this article. Difference between keloid and hypertrophic scar compare. Background hypertrophic scars and keloids result from an abnormal fibrous wound healing process in which tissue repair and. Both a hypertrophic scar and keloid scar are considered abnormal scarring of the dermis skin. Moreover, hypertrophic scar is red or pink in color, firm, pruritic, does not extend beyond the margins of the wound, and tend to regress over time. Keloid scars are also an abnormal response to injury but they can grow outside the boundaries of the original injury. The following measures are helpful in at least some patients.
A hypertrophic scar generally settles in time or with treatment, but a keloid may persist and prove resistant to treatment. A hypertrophic scar is a thickened, wide, often raised scar that develops where skin is injured. Evidence to date strongly suggests a more prolonged inflammatory period, with immune cell infiltrate present in the scar tissue of keloids, the consequence of which may contribute to increased fi broblast activity with. Structure of the collagen nodule from hypertrophic scars and keloids. Scar classification mature scar superficial macular scars immature scar ice pick scar linear hypertrophic scar rolling scars widespread hypertrophic boxcar scars minor keloid major keloid contractures 6. Emollients creams and oils polyurethane or silicone scar reduction patches. Based on your photo, i presume your initial injury was acne. Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination. Keloids are considered a benign tumor, but they are mainly a cosmetic nuisance and never become malignant. Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. May 01, 2020 a new uniform protocol of combined corticosteroid injections and ointment application reduces recurrence rates after surgical keloid hypertrophic scar excision. Aug 08, 2017 a hypertrophic scar is a raised mass of collagen that develops where the skin was injured. Scars are common during the wound healing process, but a hypertrophic scar is a result of an abnormal response to a trauma or injury.
Inefficient definition of skin was progression free or became worse. See also cpb 0062 burn garments, cpb 0244 wound care, cpb 0551 radiation treatment for selected nononcologic indications, and cpb 0559 pulsed dye laser treatment. Powerpoint presentation on hypertrophic scars and keloids. Like keloids, hypertrophic scars are more common in darker skin types. Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. Onion extract and heparin exert similar antiproliferative effects that depress fibroblast proliferation and reduce scar size in the case of excessive scar formation in htss and keloid scars. A scar that grows beyond the boundaries of the original wound is called a keloid scar and a scar that is raised above the skin level but grows within the boundaries of the original wound is known as a hypertrophic scar. Clinical appearance of hypertrophic scar hs and keloid.
Keloid scars are similar but are not the same thing as a hypertrophic scar. An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids. Lesions generally grow wider than the boundaries of a. Aberrations in the levels of cytokines, including interleukins 6, and 15 may also have a role in keloid formation. Hypertrophic scars and keloids are formed as a result of the process of. Depending on where the wound is, there are different types of scars formed. Hypertrophic scar formation following burns and trauma plos. A hss on upper back that developed after excision of. Hypertrophic and keloid scarring lazaderm free consult. In the medical literature, a hypertrophic scar is generally described as an overgrowth of scar tissue that remains within the boundaries of a wound. Hypertrophic scar definition of hypertrophic scar by. The article processing charge was paid by the authors.
They are the consequences of uncontrolled synthesis and deposition of dermal collagen. Although a sueloidea hereditary pattern has not been demonstrated, keloid and hypertrophic scars are more common in individuals of the same family. Although triamcinolone acetonide tac is one of the most common and effective treatments for keloids and hy. The main difference between a hypertrophic and keloid scar is that hypertrophic scars will stay within the boundary of the original lesion and may spontaneously mature and regress with time. Keloid scar is usually projecting above the level of the adjacent skin, 11 whereas hypertrophic scar is usually elevated, but not more than 4 mm above the skin. Adiponectin is involved in connective tissue growth factorinduced proliferation, migration and overproduction of the extracellular matrix in keloid fibroblasts. Keloid and hypertrophic scar pathology huang et al. They tend to be more reddish pink, usually dont project, and dont get as big as a keloid. Sometimes following inflammation eg acne vulgaris, chickenpox occasionally a keloid scar appears to be spontaneous, especially on the upper trunk. Aug 20, 2010 a hypertrophic scar is a scar that resembles a speed bump raised but confined to the area of the original injury. Contracture, hypertrophic, keloid, scar keloids and hypertrophic scars htss are fibrous tissue outgrowths that result from a derailment in the normal woundhealing process. Depending on where the wound is, there are different types of scars. The cryoshape probe is a quick and effective keloid and hypertrophic scar treatment method that treats the deep scar tissue by freezing the entire scar.
Hypertrophic scar and keloids scar wound healing free. Hypertrophic scars occupy the site of the original acne lesion, while keloid scars grow beyond the boundary of the original wound. A wound on skin if deep will leave a reminder in the form of scar. Hypertrophic keloid scars unlike the more common atrophic scars, here we see extra tissue where the scar is, in the form of a bump. Intralesional corticosteroids can decrease the scar size. A case series reported the use of redlight malpdt in 20 patients with keloids divided in 3 groups. A keloid is usually defined where the scar is well beyond the expected limits of healing. Hypertrophic and keloid scars represent an excessive connective tissue response.
The skin has an amazing ability to heal, but it is not always perfect. Patients at high risk of keloids are usually younger than 30 years and have darker skin. Hypertrophic scars are confined to the original wound site, whereas keloids, by contrast, extend beyond the original wound site. The first description of keloids dates back to approximately 1700 be in the ancient egyptian writing of the smith papyrus documents. An example is a marble sized lump at the site of a simple ear piercing. They are frequently associated with a variety of characteristics including hardened, ropelike protrusions, raised surfaces and excessive. Some people, in contrast, form hypertrophic or keloid scars after skin injury. Keloid and hypertrophic scars are usually thick, raised, unattractive masses of collagen at a site where the skin has been injured.
Difference between keloid and hypertrophic scar compare the. They are harmless, but may cause cosmetic concerns. These scars are characterized by dysregulated growth with excessive collagen formation, and can be cosmetically and functionally disruptive to patients. Any break in the skin, including a surgical incision, can cause a scar. They can also be caused by scrapes, burns, cuts, and injuries that are selfinflicted. Management of keloids and hypertrophic scars american. They happen in patients with a history of keloid scarring, a family history of keloids, and in specific sites prone to keloid. Abstract background the treatment of keloids and hypertrophic scars remains a challenge. In a typical wound, anabolic and catabolic processes achieve equilibrium approximately 68. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Keloids form more frequently in polynesian and chinese persons than in indian and malaysian persons.
Operating on a keloid usually stimulates more scar tissue to. Hypertrophic scars can be thick, but dont extend beyond the confines of the initial skin injury, explains dr. Is a hypertrophic scar the same as a keloid or what is the difference. Pdf hypertrophic scars and keloids contemporary concepts. Patient and surgical factors contributing to the development of this condition are discussed. While treatment for keloids and keloid surgery can be extended and adapted to hypertrophic scar treatment, in most cases surgeons consider hypertrophic. Hypertrophic scar and keloids free download as powerpoint presentation. All posas components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly p keloids. Keloids and hypertrophic scars represent an exuberant healing response that poses a challenge for physicians.
Our results reveal a fast and abiding improvement of both keloid and hypertrophic scars after treatment with the combination therapy. The main differential diagnosis of keloid is hypertrophic scar, also called. Eyelids, cornea, palms, mucous membranes, genitalia and soles are generally less affected 14. This chapter discusses keloid scars, which extend beyond the original defect scar and persist for many years, and hypertrophic scars, which are smaller, remain confined to the initial defect scar and tend to improve with time. A keloid is a benign, welldemarcated area of fibrous tissue overgrowth that extends beyond the original defect. Soliton to announce keloid and hypertrophic scar clinical. Hypertrophic and keloid scars represent one of the main aesthetic and functional defects in patients after trauma, surgery, or burn. Jun 12, 2018 trauma to the skin, both physical eg, earlobe piercing, surgery and pathological eg, acne, chickenpox, is the primary cause identified for the development of keloids. Treatment can be applied once every 7 days up to once every 3 weeks. What is a hypertrophic scar formation, images, pain, keloid. The objective of this study is to investigate the morphological features in depth. Significant improvement in hypertrophic scars was found in scar pigmentation.
Basal cell organization was regular and palliating in keloid scars 86. Laser therapy for keloids and hypertrophic scars is discussed separately. Hypertrophic scars are scars that are large and raised but are confined to the area of initial injury. Keloids and hypertrophic scars may cause functional impairment and cosmetic disfigurement and are often associated with low selfreported patient quality of life. From tiny, neat, almostimperceptible to hypertrophic and onto major keloids. Keloid and hypertrophic scars are the result of chronic. Hypertrophic scars and keloids page 2 of 20 06042015. Wound healing involves a complicated, concurrent process that occur mainly in three phrases, an inflammation phase, a granulation tissue formation phase, and a matrix formation or remodeling phase. Keloid scars are red or pink and grow to become larger than the area of the actual injury. Burn victims who do not have a wound properly dressed will often develop a hypertrophic scar. A hypertrophic scar is a thick and raised scar in which the excess tissue remains within the boundaries of the original injury.
Here you can read posts from all over the web from people who wrote about hypertrophic scar and keloid, and check the relations between hypertrophic scar and keloid. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. To an injury eg accidental trauma, burn, piercing etc, which may be trivial. The presence of foreign material, infection, hematoma, or increased skin tension can also lead to keloid or hypertrophic scar formation in susceptible individuals. Apart from normal skin healing, there are three main types of scars that can occur on the skin. Hypertrophic scarkeloid max superspecialty ortho clinic. Botulinum toxin type a for the treatment and prevention of. Keloids tend to form on the earlobes, shoulders, cheeks and chest. The treatment of hypertrophic scar, keloid and scar contract. Hypertrophic scars and keloids are often discussed together since technically, keloids are a form of hypertrophic scar. Feb 20, 2015 keloids are scars that extend beyond the borders of initial injury. A sterile cryoneedle is inserted into the core of the scar and liquid nitrogen is forced to freeze the cryoneedle and the abutting scar tissue around it. Background hypertrophic scars and keloids result from an abnormal fibrous wound healing.
The clear mechanisms underlying hypertrophic scars and keloids are still not clearly understood. What is the pathophysiology of keloids and hypertrophic scars. Currently, no objective diagnostic criteria have been formulated to indicate when a scar can be. Hypertrophic scars affect men and women from any racial group equally, although people between the ages of 10 and 30 years old are more likely to be affected. Scars hypertrophic and keloid primary care dermatology. Keloids and hypertrophic scars develop as a result of a proliferation. The wound boundary shrinks as more scar tissue forms. Keloids may be uncomfortable or itchy and extend well beyond the original wound. All posas components showed a reduction in scar score, while scar relief, pain, itchiness, and surface area improved significantly p jun 20, 2017 current therapeutic approach to hypertrophic scars.
Well, keloids usually develop after 6 months and should grow beyond the original site of injury or scar. Hypertrophic scars and keloids may follow local skin trauma or inflammatory skin disorders like laceration, tattoos, burns, injections, earpiercing, vaccination, bites, acne, abscess or surgery. Keloids and hypertrophic scars are associated genetically with hlab14, hlab21, hlabw16, hlabw35, hladr5, hladqw3, and blood group a. Keloid scars are caused by an overproduction of the fibrous tissue that repairs the skin after an injury, piercing, or surgery. Keloids and hypertrophic scars can also be differentiated by. Histology histologically, both hypertrophic scars and keloids contain an. What treatment is best for hypertrophic scars and keloids. Keloid and hypertrophic scar formation, prevention, and. It is a result of an abnormal response by your body to an injury. Pdf in the context of growing aesthetic awareness, a rising number of. The study showed evidence of the flattening of raised scars due to verapamil in both hypertrophic and keloid scars. If so, the larger scar would be classified as a keloid.
With a controlled healing process, a new keloid can be prevented. Keloids tend to recur following excision, whereas new hypertrophic scar formation is rare after excision of the original hypertrophic scar,15. It can arise soon after an injury, or develop months later. Hypertrophic scars occur with more frequency than keloids. Keloids and hypertrophic scars present a major therapeutic dilemma to the dermatologist because of frequent recurrences. Wiley periodicals, inc american society for dermatologic surgery, inc. A keloid is a scar caused by the overgrowth of tissue from skin injuries such as burns, scratches, insect bites, or body piercings. Ogawa r queloixea and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Pdf on feb 8, 2019, rei ogawa and others published keloids and hypertrophic scars can now be treated completely by multimodal therapy, including surgery, followed by radiation and corticosteroid.
What is a hypertrophic scar and how does it look like in images. A keloid scar is a firm, smooth, hard growth due to spontaneous scar formation. Keloids and hypertrophic scars can be both painful and pruritic. Are commonly raised more than 4 mm from the skins surface. This type of scar is usually confined to the original site of trauma. The topical gel preparation includes 10% aqueous onion extract, 50 u heparin per gram of gel, and 1% allantoin gel, and this formulation has been used for. Keloid and hypertrophic scar clinical presentation. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and. A better understanding of keloid pathogenesis may lead to improved therapies by which keloid growth and regrowth may be obviated. However, these types of scars occur more often, dont get as big as keloids. They may form on any part of the body, although the upper chest and shoulders are especially prone to them. Hypertrophic scars and keloids are both characterized by excess fibrous tissue at a site of injury in the skin. Hypertrophic scars and keloids can be described as variations of typical wound healing.
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