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Scars are an unfortunate fact of life. Their main goal is to reconnect skin that has been injured. At first, they may be red or dark and rose after the wound has been cured but will become paler and flatter naturally over time, producing a flat, pale scar.

For reasons that are still not completely understood, some persons develop raised scars that are red and thick and may be itchy or painful. Others form scars that grow beyond the site of a wound, known as keloid scars.

Keloid scars are basically engrossed, itchy, puckered scars that grow beyond the edges of a wound or incision and rarely regress. They appear when the body keeps producing tough, fibrous protein (known as collagen) after a wound has healed.

Keloid scars can result from any kind of injury to the skin, including bruises, tattoos, insect bites, injections or surgical procedures, etc. Keloid scars can appear anywhere on the body, but most commonly appear over the breastbone, on earlobes and on shoulders.

Keloids are fibrous tumors characterized by a collection of atypical fibroblasts with high accumulation of extracellular matrix components, mainly elastin, fibronectin, collagen, and proteoglycans. Histologically, keloids contain relatively acellular centers and engrossed, abundant collagen accumulations that create nodules in the deep dermal portion of the lesion. Keloids present a clinical challenge that must be addressed as these lesions can produce significant pain, pruritus (itch) and physical disfigurement, may not improve in appearance over time, and can even restrict mobility if located over a joint.

Unlike keloids, hypertropic scars are confined to the wounded site and usally flatten out over time. Hypertrophic scars can be difficult to distinguish from keloid scarring histologically and biochemically because both kinds produce larger amounts of collagen than normal scars. Both can be caused|the result of surgery, accidents and even acne.

Hypertrophic scars, however, will often exhibit declining collagen production after about six months. Hypertrophic scars contain about twice as much glycosaminoglycans as normal scars, and this and enhanced artificial and enzymatic reactions produce significant changes in the matrix which affects the mechanical capabilities of the scars, including minor extensibility that makes them feel firm.

As with hypertrophic scarring, persons having one keloid scar are likely to be prone to this condition in the future and should speak with their doctor or surgeon if they are likely to require injections or to have any kind of surgery.

Atrophic scars are recognized by a thinning and reduced elasticity of the skin due to an alteration of normal skin architecture. An example of an atrophic scar is striae distensae, also known as stretch marks. This type of scar can also be produced by acne lesions.