Keloid and Hypertrophic Scars: Difference
Updated: Sep 1
Both keloid and hypertrophic scar are two types of excessive scarring of the skin, but are often confused because of an apparent lack of morphological differences.
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Keloids are abnormal proliferation of scar tissue formed as result of trauma to the reticular layer of the dermis which consists mainly of collagen and fibroblasts. Incidences of keloid are high in darker skin individuals of African, Asian, and Hispanic descent than Caucasians. Both genetic and environmental factors play an important role in the development of keloids.
Keloids do not regress with time, are difficult to revise surgically and do not provoke scar contractures. Keloids contain large, thick collagen fibers composed of numerous fibrils closely packed together. Keloidal tissue extends beyond the initial site of trauma caused due to acne,chickenpox,surgery,wounds,burns and others. Patients may complain of pain, itching, or burning. Treatments currently done to improve keloids include intralesional or topical steroids, cryotherapy, surgical excision alone (high recurrence) , surgical excision with combination treatment, radiotherapy, and laser therapy.
Hypertrophic scars, are known to regress over time or with early prevention like silicone gel or sheets,pressure dressings and other topical steroidal ointments or non-steroidal scar improvement ointments. Hypertrophic scars occur when there is a lot of tension around a healing wound due to trauma like surgery,cuts,grazes or other wounds. These scars exhibit modular structures in which fibroblastic cells, small vessels, and fine, randomly organized collagen fibers not of keloidal degree are present. Hypertrophic scars affect men and women from any racial group equally, although people between the ages of 10 and 30 years old are more likely to be affected.
Characteristics of a hypertrophic scar include:
restricting movement, as the skin is no longer as flexible
forming within the boundaries of the original wound
being red and raised to start with but becoming flatter and paler over time
creating healing tissue that is thicker than usual
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