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Hypertrophic Scar vs Keloid

Hypertrophic scars and keloids are both raised, firm scars formed from excess fibrinogen production and collagen during healing.

MnemonicBasisHypertrophic scarKeloid
BBehaviorNatural regressionNo spontaneous regressio
AAcutenessAppears in weeksAppears over months to years
DDemographicAll races affectedMore prevalent in Asian/Afro-Caribbean races
Positive family history
SSymptomsItch (mast cells)Itch, Pain, Sensitivity
CCollagen3X increased production
Type III collagen
Well organized
Parallel to epidermis
With myofibroblasts
20X increased production
Type I + Type III collagen
Poorly organized
Random to epidermis
Without myofibroblasts
AAreaRemains within wound bordersExtends beyond wound borders
RRecurrenceNoYes
SSiteExtensor surfaces
Skin creases
Earlobe
Chin
Neck
Shoulder
Chest
Deltoid regions
Knees
Hypertrophic scar
User:Cgomez447, CC BY-SA 3.0, via Wikimedia Commons
Keloid
Htirgan, CC BY-SA 3.0, via Wikimedia Commons

Management

ModalityIndicationComments
Occlusive dressingHypertrophic scar & Keloid↓ delivery of blood, oxygen & nutrients to scar → ↓ collagen synthesis
23 hours/day
Works best immediately after surgery/injury
Compression therapyHypertrophic scar & KeloidThinning effect on the skin and reduces the cohesiveness of the collagen fibers
Intralesional steroidsHypertrophic scar & KeloidEvery 4-6 weeks for several months
Surgical excisionHypertrophic scar & KeloidEnsure tension-free primary closure
RadiationRecurrent KeloidBegun the day after surgical excision
Newer adjuvant & emerging therapiesInterferon, 5-FU, Imiquimod, Tacrolimus, Bleomycin, Retinoic acid, Botulinum toxin A
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