Recent Articles of Interest

When a scar is thickened, it doesn't invade normal tissue and lies across the relaxed 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 normal tissue, then it is called a keloid scar. All types of scarring can appear on different areas of the skin, but some areas like the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are uncommon responses to damage. However, a keloid is an abnormal scar that grows beyond the limits of the original site of skin damage.

Keloids have the clinical appearance of an elevated amorphous growth and are usually linked with pruritus and pain. Microscopy observation shows randomly disposed collagen fibers in a dense connective tissue matrix, making keloid removal a difficult task. In normal scars, 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 limits of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis grow to a certain size and subsequently stabilize or regress. Like keloids, hypertrophic scars are linked with negative wound healing factors.

There are no particular characteristics that can indicate what will be the ultimate appearance of a scar or what type of scar it will be. The way in which a wound cures is different for every person 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 exaggerated scarring observed clinically that require different treatment approaches. The clinical signs 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, medical differences between hypertrophic scars and keloids have long been known by plastic surgeons and specialists. Yet, translating these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. This report is an attempt to clarify the longstanding discussion involving these 2 similar yet separate and nonidentical entities by explaining the reported points of individualization 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 are chronic deforming dermatoses with a strong resistance to treatment. The aim of our study was to evaluate for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life deprivation as much as patients with other chronic skin diseases. An item-pool was made changing and complementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical deprivation) of the questionnaire with 9 and 5 items, respectively, were established. Test-retest reliability of the questionnaire was optimal (corr>0.9). Good validity was proposed by the correlation of physical deprivation 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 linked with pain and restriction of mobility, although the correlations were lower. This study shows for the first time an impairment of quality of life in a large group of sufferers with keloid and hypertrophic scars.