Acne Treatments Guide - Articles

When a scar is thickened, it does not invade healthy tissue and lies across the normal skin tension lines (creases in the skin). This kind of scar is referred to as hypertrophic.

In the case that it is an elevated scar and invades healthy tissue, then it is called a keloid scar. All kinds of scarring can appear on different areas of the body, but some areas such as the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are uncommon responses to damage. However, a keloid is an aberrant scar that grows beyond the boundaries of the original site of skin damage.

Keloids have the clinical look of an elevated amorphous growth and are usually associated with pruritus and pain. Microscopy analysis reveals randomly disposed collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scars, the collagen bundles are arranged parallel to the skin surface.

A hypertrophic scar is a widened or unattractive scar that does not grow beyond the original boundaries of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis grow to a certain size and then stabilize or regress. Like keloids, hypertrophic scars are associated with adverse wound healing factors.

There are no particular characteristics that can reveal what will be the ultimate look of a scar or what kind of scar it will be. The way in which a wound cures is different for every individual and is determined by genes, the environment and how you care for it.

Keloid or hypertrophic scar: A review of the literature

Atiyeh BS, Costagliola M, Hayek SN.

Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Keloid and hypertrophic scars are two kinds of excessive scarring observed clinically that require different treatment approaches. The clinical course and physical look define keloids and hypertrophic scars as separate entities; however, they are usually confused because of an apparent lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scars and keloids have long been recognized by plastic surgeons and specialists. Yet, translating these differences into morphologic or biochemical distinctions has created much conflict in the literature. The present report is an attempt to explain the longstanding controversy involving these 2 similar yet separate and nonidentical entities by explaining the reported points of individualization as well as the similarities.

Quality of life of patients with keloid and hypertrophic scarring.

Bock O, Schmid-Ott G, Malewski P, Mrowietz U.

Primary Health Care Center, Halsan 2, Fabriksgatan 17, 55 185, Jonkoping, Sweden.

Keloid and hypertrophic scarring represent chronic disfiguring dermatoses with a high resistance to therapy. The objective of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life deprivation as much as patients with other chronic skin diseases. An item-pool was made changing and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was given to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical deprivation) of the questionnaire with nine and five items, respectively, were established. Test-retest reliability of the questionnaire was optimal (corr>0.9). Good validity was proposed by the correlation of physical deprivation with pain (P less or equal to 0.001), pruritus (P less than 0.001), and the proportion of restriction of mobility (P less than 0.001). The psychological scale was associated with pain and restriction of mobility, although the relationships were minor. This study shows for the first time a deprivation of quality of life in a large group of sufferers with keloid and hypertrophic scarring.

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