The Difference Between Keloid & Hypertrophic Scars

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Scars are a natural part of the body’s healing process, occurring whenever the skin repairs wounds caused by accident, surgery, or disease. However, not all scars are created equal. Among the various types, keloid and hypertrophic scars are particularly notable for their distinct appearances and the unique challenges they present. Understanding the differences between these two types of scars is crucial, as it influences both the approach to treatment and the management strategies to prevent their progression.

Keloid and hypertrophic scars, while similar in being more prominent than normal scars, differ significantly in their causes, growth patterns, and treatment responses. Here, we aim to delineate these differences clearly, providing a comprehensive overview that can help patients identify which type of scar they might have and understand the best options for treatment and management.

What Are Keloid Scars?

Keloid scars are a result of an overly aggressive healing process, where excessive collagen production leads to a raised scar that extends beyond the boundaries of the original wound. These scars are not only notable for their size and texture but also for their tendency to grow progressively over time.

Characteristics of Keloid Scars

Keloids are thick, nodular, and typically have a rubbery texture. They can vary in colour from pink to red or even dark brown, depending on the individual’s skin tone and the age of the scar. Keloids often appear shiny and can feel tender or itchy, sometimes causing significant discomfort or pain.

Causes and Typical Locations

Keloid formation is influenced by genetic factors and is more common in people with darker skin tones, such as those of African, Hispanic, and Asian descent. They can develop from any skin injury, including surgical cuts, acne, burns, chickenpox scars, ear piercing, and even minor scratches. Common locations for keloid scars include the chest, shoulders, earlobes, upper arms, and cheeks.

Symptoms That Distinguish Keloids

Unlike other types of scars, keloids:

  • Extend beyond the edges of the original wound or incision.
  • Continue to grow and thicken over time, rather than diminishing.
  • Can recur even after removal, often growing back larger than before.

The persistent and often expanding nature of keloids makes them particularly challenging to treat and manage. Their tendency to recur and the discomfort associated with their size and sensitivity underscore the need for targeted treatment strategies, which differ significantly from those used for more common types of scars.

What Are Hypertrophic Scars?

Hypertrophic scars are raised scars that are confined to the boundary of the original wound, unlike keloids, which spread beyond it. These scars typically develop after an injury or a surgical procedure and are characterised by their red, raised, and rigid nature.

Characteristics of Hypertrophic Scars

Hypertrophic scars are thick and raised initially but differ from keloids in several key aspects. They are usually pink or red and may feel warm to the touch in the initial months. Over time, they may remain raised but tend to become less red and softer, often improving within a year without treatment.

Causes and Common Locations

Hypertrophic scars can occur in any individual, regardless of skin type, following any injury that involves the deep layers of the skin. They are commonly seen after burns, injuries, or surgeries, especially in areas of high tension such as the shoulders, neck, knees, and ankles.

Identifying Features

The key features that distinguish hypertrophic scars from keloids include:

  • Remaining within the boundaries of the original wound.
  • Typically not expanding over time in the way keloids do.
  • Showing a tendency to improve naturally, often within a year after the injury.

Understanding these distinctions is crucial for effective treatment, as the approaches for managing hypertrophic scars can differ markedly from those used for keloids.

Key Differences Between Keloid and Hypertrophic Scars

Both keloid and hypertrophic scars are forms of excessive scar tissue that result from the skin’s healing process after an injury. However, their differences are significant:

  • Keloids are irregular and can grow beyond the wound’s original borders, while hypertrophic scars are raised but confined to the injury site.
  • Keloids are notoriously difficult to treat, with a high propensity for recurrence after removal. Hypertrophic scars, however, generally respond better to treatments and may even resolve on their own over time.

These differences are critical for determining the appropriate treatment strategy, which can include everything from silicone sheets and pressure garments to more invasive procedures like steroid injections or surgical removal.

Treatment Options for Keloid and Hypertrophic Scars

Understanding the distinct nature of keloid and hypertrophic scars is crucial in selecting the most effective treatment strategies. While some treatments may overlap, each type of scar often requires a tailored approach due to its unique characteristics.

Treatment for Keloid Scar Removal

  1. Corticosteroid Injections: One of the most common treatments for keloid scars, these injections help reduce inflammation, flatten the scar, and alleviate discomfort. They are often administered several times at intervals to achieve the best results.
  2. Surgical Removal: Keloids can be surgically removed, but this method carries a risk of the keloid forming again, sometimes larger than before. Post-surgical treatments, such as further steroid injections or pressure dressings, are typically necessary to minimise recurrence.
  3. Laser Therapy: Various types of lasers can be used to reduce the size and redness of keloids, improve the texture, and lessen the pain or itchiness associated with them.
  4. Cryotherapy: Freezing the keloid with liquid nitrogen can reduce its size by damaging the scar tissue. This method is more suitable for smaller keloids.

Treatment for Hypertrophic Scars

  1. Corticosteroid Injections: These can also be used for hypertrophic scars to reduce thickness and relieve discomfort, though they are typically required less frequently than for keloids.
  2. Pressure Therapy: Wearing pressure garments or applying pressure bandages can be particularly effective for hypertrophic scars, especially after burns. This method helps to prevent the scar from raising and becoming more rigid.
  3. Laser Therapy: Laser treatment can help smooth out hypertrophic scars, reduce redness, and improve overall appearance.
  4. Surgical Revision: In cases where hypertrophic scars are severe or do not respond to other treatments, surgical revision might be considered. This procedure is often followed by preventive measures to ensure the scar heals smoothly.

Prevention Tips for Keloid and Hypertrophic Scars

Preventing these scars where possible is crucial, especially for those who are prone to severe scarring. Here are some general tips:

  • Immediate and effective treatment of wounds can prevent abnormal scar formation. This includes keeping the wound clean, moist, and covered.
  • Reducing the tension on healing wounds with proper suturing techniques and positioning can help prevent both keloid and hypertrophic scars.
  • For individuals prone to keloids, avoiding elective surgeries and body piercings, particularly in high-risk areas, can be crucial.

Final Thoughts

Understanding the differences between keloid and hypertrophic scars is essential for effective management and treatment. While both scar types can be challenging, modern dermatological advances offer several effective treatments to improve appearance and reduce discomfort. For best results, consulting with a dermatologist who can provide personalised advice and treatment plans is highly recommended.

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