Keloid and Hypertrophic Scars
Also known as: hypertrophic scarring, keloids.
What are keloid and hypertrophic scars?
A hypertrophic scar may develop as part of the skin's response to injury and is a reddish, itchy, firm, normally raised, thicker-than-usual form of scar that’s similar in color and texture to normal skin. They do not get bigger over time and may get better in 12-24 months without treatment.
A keloid scar is also the skin's response to injury (or the presence of foreign material), but the keloid scar is a firmer, flat or stalked exaggerated overgrowth of dense scar tissue that develops after the skin heals and is larger than the injured area. It tends to get bigger over time.
What causes keloid and hypertrophic scars?
Keloid and hypertrophic scars can occur when the body’s wound healing response does not progress like it normally should. In most cases, wound healing involves three phases, which are inflammation, proliferation and remodeling. When this process gets interrupted, the result can be these atypical scars instead of typical wound healing. Why this occurs isn’t exactly clear, however.
Certain factors can put you at a greater risk of developing keloid or hypertrophic scars. Those include:
- Certain types of skin irritation, particularly severe burns, severe acne, insect bites, skin piercing, chicken pox or herpes zoster infections.
- Whole body inflammation.
- Infection that leads to improper wound healing.
- Genetic factors due to a family history of keloid or hypertrophic scars.
What are the symptoms of keloid and hypertrophic scars?
If a keloid or hypertrophic scar occurs, they are usually easy to identify based on the physical symptoms:
- The scar presents with raised, thick and hardened tissue on the wound site.
- The scar can have a pink, purple or red hue to it.
- They typically develop a month or two after an injury.
- The scars are most frequent on the back, chest, upper arms or other areas on the upper trunk of the body.
If keloid or hypertrophic scars get reaggravated due to another injury, sunburn or other reasons, they can cause additional symptoms such as pain, tenderness or itching. If the scars occur over a joint in the body, they can limit movement and cause problems with the use of the arms or legs.
How to prevent keloid or hypertrophic scars:
It’s difficult to completely eliminate your risk of keloid and hypertrophic scars, but you can take measures to protect yourself from the risks. If you experience an injury or a wound, for example, you can practice good wound care by gently washing the area with soap and water, and then applying a healing ointment as needed. A silicone gel pad or a pressure pad can also help protect the wound while it heals.
Other protective steps include avoiding wounds as much as possible, such as avoiding body piercings, tattoos or dangerous activities that can lead to wounds. If you are at risk of keloid or hypertrophic scars, you may also want to avoid elective surgeries. You can talk to your doctor about these concerns prior to any procedures. In some cases, getting enough vitamin D can provide a protective effect before elective surgeries to prevent the development of these scars.
What are the treatments for keloid and hypertrophic scars?
In most cases, no treatment is needed for hypertrophic scars.
For a problematic keloid scar, treatment depends on its location, size, and depth, as well as the age of the child. Treatments include occlusive dressings, compression therapy, injection of corticosteroids into the scar, cryosurgery, radiation, and a wide range of medications and over the counter drugs. Many new therapies are becoming available.
Reviewed by: Jack Wolfsdorf, MD, FAAP
This page was last updated on: May 22, 2024 02:04 PM