Keloid Scars and Hypertrophic Scars

Individuals who suffer from acne and acne scars often search for ways of removing those scars or making them less noticeable. Fortunately, an incredibly small percentage of them ever have to deal with keloid scars or hypertrophic scar tissue.

Occasionally, scar tissue will enlarge spontaneously and form a firm, smooth growth called a keloid. These can become uncomfortable or itchy and may actually grow to be larger than the original wound. If these scars are in an area of the body where they receive consistent trauma or irritation from clothing or other areas of the body they can actually grow larger.

Interestingly, keloid scars can begin soon after the injury or may develop months later. Doctors and researchers are not sure why keloid scars appear. Most people never form a keloid scar and others will develop them after a minor injury, even insect bites or pimples. Keloids can form on any part of the body but the upper chest and shoulders are especially prone to them.

Researchers do know that dark skinned individuals will form keloid scars more easily than Caucasians. And individuals from Middle Eastern countries will form them more easily than those from Scandinavia or Nordic decent. This is often because the amount of melanin found in the skin of those individuals who have darker complexions is much higher than in those who are lighter skinned. Keloid scars are usually a cosmetic problem and almost never become malignant.

A keloid scar will be raised, red and develops at the site of an injury. After being wounded, connective tissue and skin cells begin to multiply to repair the damage. A scar is made up of connective tissue deposited in the skin to hold the wound together. When an individual develops a keloid scar the fibroblasts continue to multiply even after the wound is filled and projects tissue above the surface of the skin to form large mounds of scar tissue.

While most people never formed these scar tissues it is estimated that they occur in about 10% of people, men and women affected equally. A keloid scar occurs when it is larger or wider than the area of injury. A hypertrophic scar is occurs when the changes are limited to the area of injury alone.

A hypertrophic scar is characterized by a red, raised fibrous lesion that does not expand beyond the boundaries of the initial injury. Interestingly, they can undergo partial spontaneous resolution and are more common after a thermal injury (burn) or other injuries that involved the deep dermis. The highest incidence of individuals who suffer from keloid or hypertrophic scars are between the ages of 10 and 20 years.

In some cases, where the original injury is located at a joint, some keloids or hypertrophic scars can cause contractures. This can result in the loss of function or significant disfigurement if the scar is located on the face. Keloid scarring will occur more frequently in individuals who are of Asian descent and as many as 16% of random sampling of black Africans report having keloids.

Individuals who suffer from burns often wear pressure dressings for months to several years after the original injury. This is a method of preventing hypertrophic or keloid scarring. Keloid scars can possibly be prevented by using pressure dressings, silicone gel pads or paper tape over the injury site when worn for 23 of 24 hours each day. The treatment for a keloid scar is usually started within the first month after the wound has healed and continues for several months afterwards. This is especially important in individuals who know they are prone to developing scarring.

Once keloid scars have formed there is no completely satisfactory treatment. Dermatologists will try freezing or cryosurgery, excision, laser, x-rays and stearate injection. The best initial treatment appears to be steroid injections into the keloid once a month. This usually makes these scars less noticeable and flattened within three to six months time. Hypertrophic scars often respond completely but keloids are much more difficult to treat.

In severe cases keloid scars can be surgically excised and given x-ray treatment to the site immediately afterwards. There has been an 85% rate of success reported in the most severe cases. Up until this time there have not been any reports of this particular treatment causing any form of cancer but the treatment is very expensive and not always covered by insurance. (1)

(1) American Osteopathic College of Dermatology: Keloids and Hypertrophic Scars