KELOIDS & HYPERTROPHIC SCARS

What are keloids or hypertrophic scars?

A keloid or hypertrophic scar is a type of raised scar that can form during the wound healing process when the healing tissue grows excessively. While hypertrophic scars remain within the boundaries of the original wound, keloids can extend beyond its borders and are often larger. Keloids can occur on any part of the body but are frequently found on the chest (especially the pre-sternal area), ears, neck, shoulders, and back.

Why are keloids or hypertrophic scars formed?

Keloids develop due to an overactive healing process following an injury. They result from excessive tissue response characterized by increased fibroblast activity and collagen production. Dark-skinned individuals are particularly susceptible to keloid formation. Various types of injuries that can contribute to keloid formation include:

• Burns
• Surgical incisions
• Acne scars
• Chickenpox scars
• Ear piercings
• Scratches
• Vaccination sites

What are the symptoms of hypertrophic scars or keloids ?

Keloids typically appear as skin-colored to hyperpigmented or erythematous raised nodular scars. Smaller lesions often show no symptoms, while larger ones may cause itching or pain. Recurrence is common and tends to be a significant characteristic of keloids.

What is the difference between a keloid and a hypertrophic scar?

Hypertrophic scars are characterized by smooth, raised plaques that are confined to the margins of the original wound. In contrast, keloids can extend beyond the margins of the original wound and may have a claw-like appearance at the periphery.

How does doctor diagnose keloid or hypertrophic scar?

Keloids and hypertrophic scars are usually diagnosed clinically, without the need for tests. In rare cases, a skin biopsy may be conducted to distinguish them from other causes of firm nodules.

How are keloids or hypertrophic scars treated?

Here are the treatment options available for keloids, although they can be challenging to eliminate, and some may recur after treatment:

• Silicone or onion extract creams: These can be applied to smaller, newer lesions to prevent further growth. They are minimally effective on older, matured lesions.
• Silicone gel sheets: Gel sheets can sometimes reduce the size and thickness of lesions. They need to be applied for a certain number of hours each day for 3-4 months. They are particularly useful for linear and small lesions.
• Intralesional injections: Keloids or hypertrophic scars are often treated with intralesional steroid or 5FU injections. These medications, when injected into the keloid, help to shrink the scar. Typically, 3-4 treatments are needed, spaced 3-4 weeks apart.
• Cryotherapy: This involves freezing the lesion using a probe with liquid nitrogen. It can be somewhat painful. After treatment, a blister forms around the keloid, which eventually falls off along with the dead tissue within 1-2 weeks.
• CO2 Laser Scar Treatment: CO2 laser therapy can effectively reduce the thickness of raised scars like keloids and hypertrophic scars, making them less noticeable. Combining CO2 laser treatment with intralesional injections of steroids and 5-FU can yield faster results and help prevent recurrences.
• Surgical Excision: Surgical removal is generally not the preferred option for keloids due to their high tendency to recur. However, for keloids on the earlobe, surgical excision may be considered. After surgery, injections of steroids are often administered at the wound edges to reduce the risk of recurrence.

TIPS

• Remember to inform your doctor about your tendency for exaggerated wound healing before any surgical procedure.
• For smaller and early lesions, consider medical treatment or using silicone gel sheets at home.
• If you notice an increase in the size of the lesion, itching, or changes in the wound within the lesion, consult your dermatologist promptly.
• Avoid scratching the lesion, as this can worsen keloids or hypertrophic scars.
• Do not attempt unapproved treatments at home.