Hypertrophic and keloid scars
Pathology / Epidemiology
- Types of wound prone to hypertrophic / keloid scar formation
- Infection
- Trauma
- Burns
- Tension (especially over the sternum)
- Wounds in certain areas of the body
- Differences in clinical course
- Hypertrophic scars tend to appear soon after injury, usually regress spontaneously
- Keloid scars appeara months after injury and continue to grow
- Treamtent options
- Non-surgical: mechanical pressure therapy (day and night up to a year) with topical silicone gel sheets
- Surgical: revision of scar with closure by direct suturing, local Z-plasty or skin grafting to avoid excess skin tension
- Intralesional steroid / LA injection - tiamcinolone in combination with lignocaine
Approach
- Scar can be on any part of the body where there has been an incision in the skin
- Describe the scar - point out that the scar area is more prominent than the surrounding skin and add details
| Features |
Hypertrophic scar | Keloid scars |
 |
 |
|
| Appearance | Confined to wound margins | Scar extends beyond wound margins |
| Site | Across flexor surfaces and skin creases | Earlobes, chin,neck, shoulder, chet |
| Age | Any age (commonly 8-20 years) | Puberty to 30 years |
| Gender | M = F | F > M |
| Race | All races | Black and Hispanic races |
| Pathology | Normal rate of collagen synthesis but increased breakdown of collagen by collagenase activity |
Increased rate of collagen synthesis (increased proline hydroxylase activity) and Increased breakdown of collagen (increased collagenase activity) |
Completion
- As how the scar affects lives
