Hypertrophic scars and keloids are abnormal wound responses in predisposed individuals and represent a connective tissue response to trauma, inflammation, surgery, or burns. Chan occupational therapy section, department of rehabilitation sciences, the hong kong polytechnic university, hung hom, kowloon, hong kong sar, china accepted 28 january 2005 abstract. Both conditions respond to the same therapies, but hypertrophic scars are easier to treat. To get rid of the scar, youll need to leave the adhesive sheet on the scar overnight, every night, for about three months.
Lesions generally grow wider than the boundaries of a wound. The development of cutaneous pathological scars, namely, hypertrophic scars hss and keloids, involves complex pathways, and the exact mechanisms by which they are initiated, evolved, and are regulated remain to be fully elucidated. Laser therapy for keloids and hypertrophic scars is discussed separately. The classification of keloids and hypertrophic scars are then discussed. In a typical wound, anabolic and catabolic processes achieve equilibrium approximately 68 weeks after the original injury. One such common scar is the hypertrophic scar, and this article aims at helping you distinguish it from the other kinds and guide you with the different hypertrophic scar treatment options available. Hypertrophic scar causes, treatment, removal and healing. Keloid and hypertrophic scar pathology huang et al. Keloid and hypertrophic scar distribution according to. Apr 24, 20 in the case of hypertrophic scarring, timing of surgical treatment is an important consideration in the treatment protocol of scar revision strategy. The skin has an amazing ability to heal, but it is not always perfect. Nevertheless, clinical differentiation between hypertrophic scars and.
Hypertrophic scar and keloids free download as powerpoint presentation. Keloid and hypertrophic scar distribution according to fitzpatrick skin phototypes move to tropical countries, they exhibit a higher incidence of these types of scars, mainly in parts of the body that are more exposed to the sun8. The hypertrophic scar is the result of an unchecked proliferation of fibrous tissue following injury to the skin. May 20, 2019 both keloid and hypertrophic scars are wounds that heal overzealously above the skin surface. Aug 08, 2017 a hypertrophic scar is a raised mass of collagen that develops where the skin was injured.
Scars hypertrophic and keloid primary care dermatology. In this study, the effect of topical application of ace on hypertrophic scar formation has. Hypertrophic scars usually stay within the confines of the precipitating trauma, while keloids invade surrounding clinically normal skin. Are commonly raised more than 4 mm from the skins surface.
Aug 01, 2009 keloids and hypertrophic scars represent an exuberant healing response that poses a challenge for physicians. The hypertrophic scar remains confined to the site of the original skin injury, unlike the keloid, and is usually linear in nature following the original surgical incision. Hypertrophic scar versus keloid hypertrophic scars and keloids are abnormal wound responses in predisposed individuals and represent a connective tissue response to trauma, inflammation, surgery, or burns. Hypertrophic scars may mature over at least a 1year period and can show significant flattening and softening without any physical manipulation. Hypertrophic scar and keloid differences, comparisons and. The effect of ceramide analogues on normal skin and. A scar that grows beyond the boundaries of the original wound is called a keloid scar. Finally, various treatment options including prevention, conventional therapies, surgical therapies, and adjuvant therapies are described in detail. Prevalence of hypertrophic scar formation and its characteristics among the chinese population cecilia w.
Sma immunostaining in normal scar, keloid and hypertrophic scar. Efficacy of topical enalapril in treatment of hypertrophic scars. Keloid and hypertrophic scars are the result of chronic. Hypertrophic and keloid scars represent an excessive connective tissue response.
Keloid and hypertrophic scars are united in a single section of this atlas because it is difficult to differentiate these scars in the early phases of their formation. Theyre often itchy or painful, and can restrict movement if theyre tight and near a joint. A hypertrophic scars begin as small cutaneous fibrotic regions arrowheads. Kinesio tape application on hypertrophic scar formation sheryl goodridge harvard university health services consultant with occupational therapy association, watertown.
A better understanding of keloid pathogenesis may lead to improved therapies by which keloid growth and regrowth may be obviated. Per their definition, both scar types rise above skin level, but while hypertrophic scars do not extend beyond the initial site of injury, keloids typically project beyond the original wound margins 3,4. A hypertrophic scar is a scar that resembles a speed bump raised but confined to the area of the original injury. In hypertrophic scars, collagen fibers are oriented somewhat parallel to the long axis of the scar, on the other hand in keloid, collagen is arranged in completely. Patients at high risk of keloids are usually younger than 30 years and have darker skin. Hypertrophic scar formation following burns and trauma plos. Basically, 2 years ago, i was playing football with friends, fell bad, and got this really bad cutgash on my knee.
Hypertrophic scars and keloids are both characterized by excess fibrous tissue at a site of injury in the skin. Like keloids, they form most often at the sites of pimples, body piercings, cuts and burns. Keloid and hypertrophic scars are common in indivi duals of darker skin 3. Hypertrophic scars usually develop rapidly after cutaneous trauma, whereas keloids develop slowly but continue to enlarge for months to years. Mostly hypertrophic scars have a better response to treatments rather than keloids even their treatment is similar. Keloids are considered a benign tumor, but they are mainly a cosmetic nuisance and never become malignant. The efforts to understand the pathogenesis of these scars are complicated further by the fact that the clinical. These scars are thick and raised, and often red in color. These diseases are sometimes considered to have the same pathological pathway, as they are hard to distinguish in. Difference between keloid and hypertrophic scar compare. Hypertrophic and keloid scars grow as an outcome of a rapid increase of the dermal tissues after any form of skin injury.
To overcome these issues, the japan scar workshop jsw has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. Hypertrophic scar removal treatment, recovery and cost. In contrast, keloids continue to evolve over time, without a quiescent or regressive phase and do infiltrate the surrounding tissue. Since both share certain similarities and the distinction between the two may be blurred in some cases, both will be discussed in this chapter. Intralesional corticosteroid injections these can have a longlasting effect, allowing the aspect of the scar to be improved. Keloids and hypertrophic scars may cause functional impairment and cosmetic disfigurement and are often associated with low selfreported patient quality of life. Keloid and hypertrophic scars can be treated with a combination of fractional carbon dioxide laser and cortisone applied topically.
Study of a patient who had three procedures on his abdominal wall. Kinesio tape application on hypertrophic scar formation. Cryosurgery using liquid nitrogen, the hypertrophic scar is practically frozen. The differences between hypertrophic scar and keloid can distinguished by their location, borders edge, their course, age at which the scar is common, the gender commonly affected, the race mostly affected and the genetic makeup of the individual. Comparative histopathological and immunohistochemical study sabah s. A keloid scar is a firm, smooth, hard growth due to spontaneous scar formation. Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. It becomes redder because your body is sending to much blood to the scared area in order to make it heal faster, but unfortunately. It is a result of an abnormal response by your body to an injury.
Development, validation, and testing of a human tissue. Hypertrophic scars and keloids can be described as variations of typical wound healing. The authors have no financial interest to declare in relation to the content of this article. Keloid scars are caused by an overproduction of the fibrous tissue that repairs the skin after an injury, piercing, or surgery. Hypertrophic scars occur when there is a lot of tension around a healing wound.
A hypertrophic scar is a thickened, wide, often raised scar that develops where skin is injured. In the world health organizations icd9, there is no diagnostic code for hypertrophic scar only keloid is listed. Recurrence rates with excision alone are 45100% and remain high even with aggressive treatment. In contrast, hypertrophic scars are characterized by erythematous, pruritic, raised fibrous lesions that typically do not expand beyond the boundaries of the initial injury and may undergo partial spontaneous resolution. Hypertrophic scars are confined to the original wound site, whereas keloids, by contrast, extend beyond the original wound site.
Hypertrophic scars and keloids may follow local skin. Keloids and hypertrophic scars may cause functional impairment and cosmetic disfigurement and are often associated with low selfreported patient quality of life 4. It can arise soon after an injury, or develop months later. Both a hypertrophic scar and keloid scar are considered abnormal scarring of the dermis skin.
It eventually turned into a hypertrophic scar, and since then, i have gotten a number of hypertrophic scars on my body 2 small ones on my chest, 1 near my elbow, and the 1 on the knee. Hypertrophic scars hts are considered to be a dermal form of fibroproliferative disorders that are caused by aberrant wound healing due to. Ace is a significant mediator in wound healing and collagen production. They not only cause esthetic problems, but also symptomatic problems such as pruritus and pain. The difference between a keloid and a hypertrophic scar is that a keloid continues to enlarge beyond the original size and shape of the wound, while a hypertrophic scar enlarges within the confines of the original wound. Because hypertrophic scars are often painful and difficult to treat, several treatments have been developed in the past several years in an effort to minimize tissue growth and wound contraction. At this stage, the strength of the wound is approximately 3040% that of healthy skin. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Tranilast was given at a dose of 300mgday for 12 weeks. Insights into the pathophysiology of hypertrophic scars and keloids. The cryoshape probe is a quick and effective keloid and hypertrophic scar treatment method that treats the deep scar tissue by freezing the entire scar. Insights into the pathophysiology of hypertrophic scars. The diagnosis of keloid was based on the clinical characteristics, among which extension of the scar beyond the original wound and.
The article processing charge was paid by the authors. Keloids and hypertrophic scars represent an exuberant healing response that poses a challenge for physicians. Whereas hypertrophic scars remain confined to the borders of the original wound and most of the times retain their shape. Early recognition of the potential development of the hypertrophic scar is critical in its management. They dont get a big as keloids, and may fade with time. A hypertrophic scar is formed when the body reacts unusually to a wound that reaches the dermal layers of the skin. Currently, reliable animal and in vitro models to identify and test novel scar. Summary keloid vs hypertrophic scar a scar that grows beyond the boundaries of the original wound is called a keloid scar and a scar that is raised above the skin level but grows within the boundaries of the original wound is known as a hypertrophic scar. Keloid and hypertrophic scars 7 the presence or absence of myofibroblasts was demonstrated by. Keloids appear as firm, mildly tender, bosselated tumors with a shiny surface and occasional telangiectasia. Why does my hypertrophic scar itch wound care society. Hypertrophic scarring tends to remain within the boundary of the initial injury, and get better with time. Excision is a hypertrophic scar removal surgery that is precisely how it soundsathe scars are cut out of the skin.
Any break in the skin, including a surgical incision, can cause a scar. In hypertrophic scar fibroblasts, increased levels of alpha 1 i and alpha 1 iii collagen mrnas were observed in fibroblasts from the edge and outside of scar tissue, while normal levels were. The development of scar contractures, hypertrophic scars, and keloids is a frustrating problem for both patients and physicians. Management of hypertrophic scars and keloids has advanced from crude, invasive methods such as gross excision and radiation to intralesional or topical agents that act on a cellular level. Healing issues that occur in keloid and hypertrophic scarring are compound, involving diverse interplay of cell functions below the surface of the skin, the bodys response to physical injury, and changes to the outer layers of. A sterile cryoneedle is inserted into the core of the scar and liquid nitrogen is forced to freeze the cryoneedle and the abutting scar tissue around it. Mar 24, 2011 hypertrophic scar cure also consists of lifestyle and dietary modifications. Differences between keloids, hypertrophic scars and normal scars include distinct scar appearance, histologic morphology.
Adverse hypertrophic scars can form after healing of fullthickness skin wounds. Nevertheless, clinical differentiation between hypertrophic scars. Keloids appear to be a more sustained and aggressive fibrotic disorder than hypertrophic scars. Apart from normal skin healing, there are three main types of scars that can occur on the skin. Hypertrophic scar an overview sciencedirect topics. A hypertrophic scar takes a long time to heal and it is best for you to try and avoid injuries to this area until it completely recovers. When excess cells are produced, a keloid or hypertrophic scar may form. Keloids and hypertrophic scars are thought to have the same clinical course. Hypertrophic scars are elevated, thickened, and are often red, pruritic, or painful. How to treat keloid and hypertrophic scarring after. Keloids and hypertrophic scars are fibrous growths that result from an abnormal connective tissue response. Keloids and hypertrophic scars present a major therapeutic dilemma to the dermatologist because of frequent recurrences.
Like keloid scars, hypertrophic scars are the result of excess collagen being produced at the site of a wound. Powerpoint presentation on hypertrophic scars and keloids. Sometimes following inflammation eg acne vulgaris, chickenpox occasionally a keloid scar appears to be spontaneous, especially on the upper trunk. Hypertrophic scar treatment can be done in many ways including cryotherapy, excision, or laser ablation. The excessive creation of collagen substances can lead to an elevated scar akin to a keloid scar. There is no consensus on what amount of posttraumatic skin scar formation is normal and what should be considered hypertrophic. Scars are common during the wound healing process, but a hypertrophic scar is a result of an abnormal response to a trauma or injury. Jun 12, 2018 a case series reported the use of redlight malpdt in 20 patients with keloids divided in 3 groups. Clinical effect and usefulness of tranilast was evaluated in 35 cases of keloid and hypertrophic scar. Both are common and frequently disturb patients greatly, both as an unsightly scar as well as a reminder.
Keloids, though medically benign, are often psychologically and socially problematic. In the world health organizations icd9, there is no diagnostic code for hypertrophic scaronly keloid is listed roseborough et al. We found the following considerations important in the examination of keloid or hypertrophic scar. Nov 14, 2014 why does my hypertrophic scar itch hypertrophic basically occurs because the skin overproduces the collagen after the skin formed a scar. A hypertrophic scar is a cutaneous condition characterized by deposits of excessive amounts of collagen which gives rise to a raised scar, but not to the degree observed with keloids. A new treatment of hypertrophic and keloid scars with. It is necessary to add vitamin e and vitamin c into the diet if you have hypertrophic scars.
Innovative approaches in scar prevention and treatment from a. These are the most common courses of treatment for the hypertrophic scar. Keloid scars are raised above the skin and are red or purple when newly formed, before gradually becoming paler. Keloids and hypertrophic scars are abnormal wound responses characterized by the overgrowth of fibroblastic tissues during skin healing. This concept implies that a scar starts out as a hypertrophic scar and later becomes a keloid, when it has exceeded.
Keloids may be uncomfortable or itchy and extend well beyond the original wound. Clinically, most appear as reddish solid masses on the skin10. Keloids and hypertrophic scars are abnormal wound responses characterized by excessive scarring. Keloid scars, unlike hypertrophic scars, have a genetic aetiology. Structure of the collagen nodule from hypertrophic scars and keloids. Hypertrophic scars are common after thermal injuries and other injuries that involve the deep dermis. How to treat keloid and hypertrophic scarring after plastic surgery the formation of a scar after any plastic surgery is a normal phenomenon. Like keloids, hypertrophic scars are more common in darker skin types. A commonly taught but confusing concept is that keloids can be distinguished from hypertrophic scars by the extension of the scar beyond the wound border. A scar that is raised above the skin level but grows within the boundaries of the original wound is known as a hypertrophic scar. Management of keloids and hypertrophic scars american. To an injury eg accidental trauma, burn, piercing etc, which may be trivial. Nevertheless, a hypertrophic scar does not develop beyond the boundaries of the original wound unlike a keloid does.
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