Articles

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

In the case that it is a raised scar and invades normal tissue, then it is called a keloid scar. All kinds of scarring can occur 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 atypical reactions to damage. However, a keloid is an abnormal scar that grows beyond the boundaries of the original site of skin damage.

Keloids have the clinical appearance of a raised amorphous growth and are usually associated with pruritus and pain. Microscopy analysis shows randomly organized collagen fibers in a dense connective tissue matrix, making keloid removal a difficult task. In normal scarring, 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 boundaries of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis reach a certain size and subsequently 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 appearance of a scar or what type of scar it will be. The way in which a wound heals is different for every individual and is determined by genetics, 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 exaggerated scarring observed clinically that need different therapeutic approaches. The clinical course and physical appearance define keloids and hypertrophic scars as different entities; however, they are often confused because of an apparent absence of morphologic differences. Nevertheless, medical differences between hypertrophic scarring and keloids have long been known by plastic surgeons and dermatologists. Yet, expressing these differences into morphologic or biochemical signs has prompted much conflict in the literature. This report is an attempt to clarify the longstanding controversy regarding these 2 similar yet individual and nonidentical entities by highlighting the reported points of differentiation 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 deforming dermatoses with a high resistance to therapy. The aim of our research was to assess for the first time the quality of life of people with hypertrophic scarring and keloids, because they suffer from quality of life deprivation as much as people with other chronic skin diseases. An item-pool was created modifying and complementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was given to 100 outpatients with keloids and hypertrophic scarring. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical deprivation) of the questionnaire with 9 and 5 items, respectively, were established. Test-retest reliability of the questionnaire was optimal (corr>0.9). High validity was suggested by the correlation of physical deprivation with pain (P less or equal to 0.001), pruritus (P less than 0.001), and the amount of restriction of mobility (P less than 0.001). The psychological scale was associated with pain and restriction of mobility, although the correlations were minor. This research demonstrates for the first time a deprivation of quality of life in a large group of patients with keloid and hypertrophic scarring.