Keloids vs. Hypertrophic Scars

Scars come in a variety of forms, and it can be confusing to tell the difference between keloids, hypertrophic scars, and other types of scars.

Keloids and hypertrophic scars–what is the difference between these? “A lot of our patients come in to discuss surgery or other treatments, and describe previous experiences with keloids,” says our cirujana plástica facial la Dra. Inessa Fishman, “and the importance of different types of scars makes a difference for treatment planning.”

How Do Scars Form?

After sustaining trauma, our skin heals the wound and develops lots of collagen, a protein to add structure and repair the injured tissue. In favorable scars, the skin comes together evenly and leaves behind a flat, light pink colored scar; the collagen remodels and the scar softens over several months after injury. “The body manages the scar healing process in a series of steps,” says Dr. Fishman, “and once the scar is healed, the body naturally stops additional scar healing attempts.”

Keloids vs Hypertrophic Scars: What Is the Difference?

Some scars can build up excessive collagen, producing a raised and sometimes itchy scar called a hypetrophic scar. Hypertrophic scars usually form in areas os high tension (like in the skin over the shoulder or the lower abdomen for a C-section incision). By clinical definition, hypertrophic scars stay within the bounds of injury, and do not grow outside of the injured area. Hypetrophic scars usually stop forming collagen and become less itchy and bothersome over time.

In contrast, some scars continue to grow collagen in a poorly-regulated attempt to repair injury. Called keloids, these scars often grow to form large balls or heaped up scar tissue well outside the bounds of injured tissue. Keloid scars form mostly likely due to genetic reasons; they can feel intensely itchy or even painful. “Keloids also have a tendency to come back despite different treatments,” says Dr. Fishman, noting they can be a frustrating problem for patients and doctors alike.

Keloid scars look different from hypertrophic scar both to the naked eye and under the microscope. Under microscopic magnification, keloids contain thick and poorly-organized bands of collagen whereas hypertrophic scars contain nodules (or tiny bumps) of collagen.

I Have Keloids. What Do I Need to Know about Them?

Individuals predisposed to keloid scarring can develop keloids from minor surgeries, ear piercings, and even ingrown hairs or bug bites! Keloids affect all ethnicities and often have a positive family history, indicating genetic predisposition. Despite their appearance and frequent pronounced growth, keloids pose no danger! Both keloids and hypertrophic scars are benign and non-contagious. Aside from appearance, some patients report bothersome itching, burning, and tenderness. Keloids don’t require treatment, but because they can appear unsightly and be itchy and painful, they can be treated with several modalities, including surgery, injections of steroids, freezing, and radiation therapy.

What Can We Do to Prevent Scars?

Treatment of scarring really starts at prevention. Besides avoiding injury, prevention starts at proper wound care and keeping the injured area clean and moisturized during the initial healing process. Proper repair of injured tissue can be important for wounds that need it. If you develop a keloid or hypertrophic scar, there are many treatment options available. Intralesional injections containing the steroid Triamcinolone and anti-scar medication 5-Fluorouracil can help soften and flatten very raised and firm scars. Very resistant and recurrent keloids can be helped with a combination of surgery, anti-scar injections, and low-dose radiation therapy.

Do you have a scar that bothers you? Want to know your treatment options for keloids or other scarring? Contáctanos to schedule your consultation toda