Hypertrophic and Keloid Scars

Question 1

What is a hypertrophic scar

Answer 1

Characterized by deposits of excessive amounts of collagen, resulting in a raised scar. Limited to the site of the original wound

Question 2

What is a keloid scar

Answer 2

Excessive scar tissue which extends beyond the original wound

Question 3

What is the pathophysiology of hypertrophic scars

Answer 3

Excessive scar tissue due to fibroblast overactivity in the proliferative phase.

Usually corrected by 1 year

Commonly results from large areas of skin damage

Question 4

What is the pathophysiology of keloid scars

Answer 4

Intense fibroblast activity continues into the maturation phase

Question 5

What type of wounds are prone to hypertrophic and keloid scars

Answer 5

Infection

Trauma

Burns

Tensions - esp. over sternum

Question 6

What are some risk factors for hypertrophic and keloid scars

Answer 6

Young age

Male sex

Dark pigmented skin

Genetic predisposition

Site - sternum, shoulders, head and neck

Tension on wound

Delayed healing

Question 7

How do you treat hypertrophic and keloid scars

Answer 7

Non-surgical:

• Mechanical pressure therapy (day and night for up to 1 year)
• Silastic gel treatment
• Intralesional steroid injection (variable response)

Surgical:

• Excision - usually leads to recurrence
• Excision and radiotherapy - not always successful and cannot be repeated
• CO2 laser - variable respones