When the body experiences trauma resulting in a wound, a scar occurs as a part of the natural healing process. Unfortunately these scars, for some, can become disfiguring. The two most commonly disfiguring scars are keloids and hypertrophic scars. To the uneducated eye they can seem to be one and the same. Both they are cosmetically undesirable and they do occur for the much the same reasons. However, treatment options and prognosis differ so it is important to be able to distinguish between the two.
A study conducted by the Department of Dermatology at the University of South Florida College of Medicine concluded, “Keloids and hypertrophic scars are benign fibrous growths that occur after trauma or wounding of the skin.” Both are a result of excessive growth of scar tissue that develops during the healing process. Neither will develop into a malignancy, so they are not medically dangerous. They can result from lacerations, tattoos, burns, injections, ear piercing, vaccination, insect bites, acne and surgery.
A keloid is classified as a benign tumor. It occurs when the connective tissue cells deposit gristle-like fibers to close a wound. These continue to grow even after the wound is filled in, forming a mound of scar tissue above the surface of the skin. A keloid usually extends beyond the original site of the trauma. It tends to range in color from dark purple to pink to reddish. Keloids usually present as a nodule, later becoming quite large. They can take up to a year to form. Though they can form anywhere, they are more commonly found on the upper chest, shoulders, back and earlobes. Unlike hypertrophic scars, keloids have been known to cause pain.
Hypertrophic scars occur with more frequency than keloids. This type of scar is usually confined to the original site of trauma. They tend to be more reddish pink, usually don’t project, and don’t get as big as a keloid. Burn victims who do not have a wound properly dressed will often develop a hypertrophic scar. These scars tend to develop rather quickly, generally within weeks of injury. They are rarely painful and tend to fade back to a normal scar on their own after a few years.
Keloids and hypertrophic scars affect about 5 to 15 percent of the population. Men and women are equally affected. Keloids are 15 times more common in non-whites. According to the Indian Journal of Plastic Surgery, keloids are more commonly observed in Asians and dark-skinned races. In contrast, hypertrophic scars occur evenly in all racial groups. Both types of scars are uncommon in the very young and the elderly, generally occurring between puberty and the age of 30.
Keloids are notoriously resistant to treatment and recur frequently, therefore making prevention key. A person with a family history of keloids would want to avoid elective surgery. Persons at high risk should immediately apply a pressure dressing when experiencing a cut or abrasion. Cryosurgery has been successful in the treatment of keloids in lighter skin. Earlobe keloids can often be surgically excised and treated with steroid injections. It should be noted that in some cases surgical removal could result in a larger scar. Laser treatment has been known to improve texture and color. Overall, combination therapies seem to yield the best results. Though hypertrophic scars will usually heal themselves, cortisone injections can accelerate the process. Occasionally a biopsy will be required to rule out other skin growths. A physician should be consulted immediately if the appearance or symptoms of the scar begin to change.