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.
Patch of fibrous tissue that replaces the normal skin tissue after wounds, trauma, burns, surgical incision, or disease
Helps to close open wounds & prevent infection
Can be painful, pruritic, & limit mobility
Delay in wound healing due to certain types of trauma eg burns, ear piercing
Extent & duration of inflammation
Magnitude of mechanical tension acting on the scar
Acne, chickenpox, BCG vaccinations, biopsy procedures, & lacerations may cause abnormal scarring
Darkly pigmented skin due to the melanocyte-stimulating hormone anomalies
Genetic phenotype (familial predisposition) in keloids
Black, Hispanic & Asians have increased risk
Asian skin has a tendency to develop hyperpigmentation & scar formation after an injury
Asians have greater collagen density than Caucasians that manifests a tendency to a more vigorous fibroplastic response during wound healing that results in hypertrophic scarring & prolonged erythema during scar maturation
Asian skin also has increased melanin that leads to increased sebum secretion that is characterized by increased proliferation of fibroblast & more vigorous collagen formation & fibroplasia during wound healing
Increased prevalence in patients <30 years old (peak 10-20 years)
Common in patients w/ elevated hormone levels (eg during puberty or pregnancy)
Skin wound healing process involves overlapping phases of inflammation, proliferation & maturation or remodelling
Hemostasis occurs & an acute inflammatory platelet & white blood cell infiltrate ensue during inflammatory phase
The occurrence and severity of hidradenitis suppurativa (HS) are associated with micronutrient status and obesity, suggesting that weight loss and dietary modifications should be considered in the treatment of HS patients, according to the results of a systematic review and meta-analysis.
Oral H1-antihistamines are the initial treatment of choice for allergic rhinitis (AR) and chronic urticaria in the primary care setting. However, in a diverse population of patients with AR and urticaria, primary care physicians are faced with the challenge of prescribing the best therapy amid a wide armamentarium of antihistamines available.