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When a scar is engrossed, it doesn’t invade healthy 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 a raised scar and invades healthy tissue, then it is called a keloid scar. All types of scarring can appear 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 uncommon reactions to trauma. However, a keloid is an abnormal scar that grows beyond the boundaries of the original site of skin injury.

Keloids have the clinical appearance of an elevated amorphous growth and are usually associated with pruritus and pain. Microscopy observation reveals randomly disposed 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 unattractive 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 then 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 kind of scar it will be. The way in which a wound heals is different for every individual 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 2 types of excessive scarring observed clinically that require 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 lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scarring and keloids have long been recognized by plastic surgeons and dermatologists. Yet, translating these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. The present report is an attempt to explain the longstanding discussion involving these 2 similar yet separate and nonidentical entities by explaining 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 treatment. The objective of our study 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 impairment as much as people with other chronic skin ailments. An item-pool was made changing and supplementing the items of the Questionnaire on Experience with Skin Complaints. The questionnaire was distributed to 100 outpatients with keloids and hypertrophic scarring. A factor analysis was used to identify 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 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 lower. This study shows for the first time a deprivation of quality of life in a large group of patients with keloid and hypertrophic scars.

The best solution to alleviate scarring and other skin imperfections now comes in the form of a cream for actinic keratosis prevention, elaborated with biological components to rejuvenate your skin.

- Grant Ferns

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