Articles

When a scar is engrossed, it doesn't invade normal 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 normal tissue, then it is called a keloid scar. All types of scarring can appear on different areas of the body, but some areas like the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are atypical reactions to damage. However, a keloid is an abnormal scar that grows beyond the limits of the original site of skin injury.

Keloids have the clinical appearance of a raised amorphous growth and are frequently linked with pruritus and pain. Microscopy observation reveals randomly organized collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scars, the collagen bundles are disposed parallel to the skin surface.

A hypertrophic scar is a widened or unsightly scar that does not extend beyond the original limits of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis reach a certain size and then stabilize or regress. Like keloids, hypertrophic scars are linked with negative wound healing factors.

There are no certain signs that can reveal what will be the ultimate appearance of a scar or what type of scar it will be. The way in which a wound heals is different for every person 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 types of excessive scarring observed clinically that need different treatment approaches. The clinical course and physical appearance define keloids and hypertrophic scars as different lesions; however, they are often confused because of an apparent absence of morphologic differences. Nevertheless, medical differences between hypertrophic scars and keloids have long been known by plastic surgeons and dermatologists. Yet, expressing these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. This report is an attempt to clarify the longstanding controversy involving these 2 similar yet individual 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 are chronic disfiguring dermatoses with a strong resistance to treatment. The aim of our research was to evaluate for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin ailments. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. The questionnaire was distributed to one hundred outpatients with keloids and hypertrophic scars. A factor analysis was used to recognize the underlying dimensions. Two scales (psychological and physical impairment) of the questionnaire with 9 and 5 items, respectively, were established. Test-retest validity of the questionnaire was optimal (corr>0.9). Good validity was proposed by the correlation of physical impairment 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 linked with pain and restriction of mobility, although the relationships were lower. This research shows for the first time a deprivation of quality of life in a large group of patients with keloid and hypertrophic scars.

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