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KELOIDS AND HYPERTROPHIC SCARS

Keloids and hypertrophic scars are abnormalities in the normal wound healing characterized by greater and more sustained extracellular matrix deposition that develops after any insult in the dermis.

It can affect the patient's quality of life, both physically and psychologically.

Hypertrophic scars are raised fibrous tissue scars that remains within the boundaries of the wound. Hypertrophic scars that resulted from surgery or trauma are called linear hypertrophic scars while those from burn injuries or extensive tissue trauma and/or infections are called widespread hypertrophic scars.

Keloids are elevated fibrous scars that extend beyond the borders of the original wound. Major keloids resulted from minor trauma while for those from genetic predisposition with autosomal-predominant features are called minor keloids.

 

 

Classification

Types of Scars
Normal Mature Scar

  • Light-colored, flat scar
  • Contracts slowly over time
  • Results from normal tissue repair

Immature Scar

  • Red, sometimes itchy or painful, & slightly elevated scar in the process of remodelling
  • Many will mature normally over time, become flat, & assume a pigmentation similar to the surrounding skin but they can appear slightly darker or paler
  • Results from normal tissue repair

Hypertrophic Scars

  •  Raised fibrous tissue scar that remains within the boundaries of the wound
  • Usually painful & pruritic
  • Due to excess mechanical stress
  • Commonly occur in wounds across flexion surfaces, the extremities, breasts, sternum & neck
  • Fewer thick collagen fibers & scanty mucoid matrix
  • Usually occur within 1 month of injury
  • Flatten spontaneously & regress w/ time
  • 2 types of hypertrophic scars:
    • Linear hypertrophic scars usually result from surgery or trauma
    • Widespread hypertrophic scars usually result from burn injuries or extensive soft tissue trauma &/or infections

Keloids

  • Elevated fibrous scars that extend beyond the borders of the original wound
  • More common in darker skin types
  • Consist of thick collagen & mucoid matrix
  • May result from minor trauma (major keloid) or genetic predisposition w/ autosomal-predominant features
  • Commonly occur on the sternal skin, shoulders, upper arms, earlobes, & cheeks
  • Appear at 3 months or later
  • Do not regress
  • Usually recur after excision

History

  • History composed of etiology, infection history, associated symptoms like pain, itching, & exposure to radiation & steroid

Physical Examination

  • Physical exam should assess also the surrounding tissue
    • Assess the color, size, texture of the scar; relationship to normal structures; presence of any tethering & contracture; changes w/ movement
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