Keloid & Hypertrophic Scar
Keloid scars are firm, smooth and dense growths that form on a healed wound. Keloid scars spread outside the area of the wound. Hypertrophic scars are formed if there is any abnormality during the healing process. Hypertrophic scars form a thick layer of skin over a wound.
Clotting begins to minimize blood loss after an injury to the skin. Consequently, the collagen and fibrous tissue form the scar tissue. This helps to repair and protect the wound. However, in some cases, this scar tissue grows excessively and forms a smooth, hard growth called keloid.
Generally, keloid scars grow beyond the original wound. They may be itchy. Moreover, they may worsen in appearance and become painful if left untreated.
Appearance - round, oval, or oblong with regular margins; some may have crab claw-like configurations with irregular borders.
- Colour - pink to cherry red.
- Texture - soft and doughy to rubbery and hard.
- Histopathology - composed of collagen clusters
A hypertrophic scar forms if the body overproduces collagen during the healing process. Consequently, the excess collagen may lead to an elevated scar. Usually, a hypertrophic scar does not develop beyond the boundaries of the original wound.
Moreover, the elastic strength of the scar helps to increase the strength of the injured skin by cross-linking collagen fibers.
These scars may thicken initially but they eventually subside. However, they always remain elevated above the wound.
- Appearance - raised above the wound, does not cross the borders of the wound, radial growth.
- Colour - pale.
- Texture - flexible.
- Histopathology - composed of collagen clusters and fibrous connective tissues.
Do & Don't for Getting Keloid & Hypertrophic Scar
DO: Consult a doctor who specialises in treating patients with ethnic skin.
DO: Keep realistic expectations from the treatment.
DO: Use a broad spectrum sunscreen daily.
DO: Use face washes that have glycolic or salicylic acid.
DON’T: Leave the house without sun protection.
DON’T: Ignore initial stages of any skin condition.
DON’T: Scrub your skin too roughly.
The treatments act by suppressing the inflammation. Additionally, the treatments aim to inhibit collagen and fibrous scar tissue production.
Generally, keloids follow the lines of injury. However, they do not stay restricted to it and can spread to normal skin as well. They tend to be itchy, tender and painful. Moreover, they are capable of interfering with limb movement. Because of these reasons, keloids are difficult to treat, prone to recur, and never regress spontaneously.
Although they are difficult to treat, there are many treatment options to remove or at least improve the appearance of keloid scars. Steroid injections into the scar are most effective for small keloids. However larger keloids require a combination of surgery and other treatments. Your doctor will determine the course of treatment based on the location of the keloid, its size and depth, and the age of the patient.
The most common treatment for keloids is injecting corticosteroid directly into the scar. The tissue doesn’t absorb the drug well enough through the skin to be effective. Hence, injections are more effective than topical applications.
This method uses liquid nitrogen to freeze and destroy the keloid scar.
Pressure dressings can be used over the injury site within a month of the wound. This may prevent keloid formation.
They help in fading out the scar. They also make the skin tone even so that the scar matches the skin color. The patient wears the silicone sheets daily for half an hour fover ten weeks for best results.
They are natural or synthetic substances that help regulate the immune system. They reduce collagen production and cause the deactivation of fibrous tissue.
Retinoids can help regulate the production of collagen and other skin cell factors. Hence, they are able to counteract the dysfunctional process in keloid stem cells. One can use them both topically or orally.
Calcium channel blockers:
In addition to inhibiting collagen and fibroid tissue production, they also reduce vascularity, pliability, height, and width of the lesions. Furthermore, injections of calcium channel blockers like verapamil given after surgical removal of keloids can also help cure or reduce recurrence rates.
They are anti-inflammatory and antiproliferative agents. Hence, they inhibit collagen synthesis and deposition. Additionally, they provide relief to the pain and itch associated with keloids.
Usually, surgery is reserved as a last resort, since it can itself lead to scar formation. Surgery can be followed by corticosteroid or verapamil injections and silicone sheeting to decrease the chances of recurrence.
Hypertrophic scars can easily be treated however keloids are persistent. Various types of hypertrophic scars require various types of treatment.
Factors such as
- Previous treatment and response
Are the key determinants to deciding the method of treatment.
Topical steroids are used for treatment of many skin issues, mainly eczema, hypertrophic scarring, and contact dermatitis. Topical steroids are mainly in the forms of creams or ointments. Moreover, they are available in different strengths of dosages. These help reduce the scarring.
This is mainly used to break down the collagen. Usually, the procedure applies different pressure for each part of the body.
Silicone gel sheeting:
Silicone gel sheeting is one of the least fussy methods. Moreover, it is a simple and effective method. Usually, patients need to apply it once a day and keep for 12-23 hours. After the initial application, it will not bother you further and is extremely easy to use.
Intralesional corticosteroid injections:
The dosage depends on the size of the scar.
This treatment improves skin color and texture.
These include a combination of hydrocortisone, vitamin E, and silicone, various emollients (creams and oils).
Polyurethane or silicone scar reduction patches:
Polyurethane patches are basically clear as well as self adhesive. They aid in the healing of the scars. Moreover, they reduce the prominence and the colour of the scar.
Oral or topical tranilast:
These help inhibit collagen synthesis.
These include vascular endothelial growth factor (VEGF) inhibitors like bevacizumab.
Photodynamic therapy (PDT), UVA-1 therapy and narrowband UVB therapy.
Invasive measures can be used to reposition or decrease the width of the scar. Although, new scars form instead of healing the old scar completely, which takes more than a year to heal.
Keloids are not harmful to general health. However, dermatologists can treat them with surgery, laser treatment or steroid injections. READ MORE
Timeline may vary or depends on your skin problems,
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Keloid & Hypertrophic Scar – Q&A
Keloid is formed as a result of an overgrowth of granulation tissue at the site of a healed skin injury. These are firm, rubbery lesions like a fibrous nodule, which occurs on the skin. Keloid is different from a hypertrophic scar, & it has a tendency to overgrow...