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

Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia
Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia

You may have heard the terms keloid and hypertrophic scar thrown around.  Both are types of scars, but they are not the run-of-the mill normal scars.  Keloids tend to be bulky and “spill over” the footprint of the wound.  A hypertrophic scar is also larger than normal, but its edges do not “spill over” the footprint of the wound.  Instead, it is raised upwards.

Scars including large scars such as keloids or hypertrophic scars follow injury to the skin, and this injury may be seemingly minor (e.g. ear piercing, acne, or a minor cut).  An exuberant scar response ensues, leading to a keloid or hypertrophic scar.

Who is more likely to develop keloids and hypertrophic scars?

Certain ethnicities are more likely to develop these big scar, especially those of African or Asian heritage.

So what can be done to treat keloids or hypertrophic scars?

First, prevention is key.  If you can prevent unnecessary trauma, this would prevent the keloids or hypertrophic scars from forming. However, sometimes the trauma is not preventable. In this case, many treatments exist.

Injections may be performed on keloids and hypertrophic scars.
Injections may be performed on keloids and hypertrophic scars.

When patients see me in the office for these large scars, I offer to inject these scars with a corticosteroid solution if appropriate.  Several injections are often necessary.  Many other treatments exist as well, and are outlined in this article.  Regardless, these large scars can reappear, even after flattening out after treatment.

 

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