Hypertrophic Scars and Keloids: Treatment, and Prevention
Understanding the characteristics of each type of scar is important because different scars have different causes and require different approaches to care.
For people with hypertrophic scars or keloids, this knowledge can help them choose the most appropriate treatment.
What Are Hypertrophic Scars and Keloids, and How Are They Different?
Hypertrophic scars and keloids both result from excessive collagen production during the wound-healing process. However, they have different characteristics.
Hypertrophic Scar
๐ The scar remains within the boundary of the original wound and does not spread beyond it.
๐ It is usually red or pink and may gradually fade over time.
๐ It may cause mild itching or pain during the early stages, but the symptoms often improve over time.
๐ The scar may gradually flatten within 6-12 months, although some raised tissue may remain.
๐ It is commonly caused by inflammation or excessive tension on the wound, such as after surgery or a burn.
๐ It often develops in areas with frequent movement, including the elbows, knees, and shoulders.
๐ It may improve naturally or with treatments such as silicone gel or silicone sheets.
Keloid
๐ The scar grows beyond the boundary of the original wound and may continue to spread into the surrounding skin.
๐ It may appear red, purple, or brown and may not fade over time.
๐ It may cause persistent itching or pain and can continue to increase in size.
๐ It does not normally flatten or disappear by itself.
๐ Genetic factors may increase the risk, and a keloid can develop even after a minor injury such as ear piercing or inflamed acne.
๐ It commonly develops in areas with high skin tension, including the ears, chest, shoulders, neck, jaw, collarbone, and middle back.
๐ It often requires more intensive treatment, such as steroid injections, laser therapy, cryotherapy, surgery, or surgery combined with radiotherapy.
Other abnormal types of scars may also occur, including:
๐ Depressed scars, which form pits or indentations below the surface of the skin
๐ Scar contractures, which tighten and pull the surrounding tissues or joints, commonly following burns or scalds
Why Do Some People Develop Keloids While Others Do Not?
Although the exact cause of keloids is not fully understood, several factors may increase the risk.
Genetics
People with a family history of keloids, such as a parent or sibling with the condition, may have a greater risk because their bodies may be more likely to produce excessive collagen after an injury.
Individual Immune Response
Each person’s immune system responds differently to injury. In some people, cytokines and fibroblasts may become highly activated and produce more collagen than necessary.
Skin Colour
People with darker skin tones, including those of African, Latin American, and Asian backgrounds, may be more likely to develop keloids than people with lighter skin.
This may be associated with melanin and differences in the inflammatory response during wound healing.
Hormones and Age
Keloids are more common during periods of significant hormonal change, particularly among:
๐ Adolescents
๐ Young adults
๐ Pregnant women
Location of the Wound
Keloids commonly occur in areas with high skin tension or frequent movement, including:
๐ The chest
๐ Shoulders
๐ Back
๐ Ears
๐ Jaw
๐ Upper arms
Type of Wound
Wounds with significant inflammation may carry a greater risk, including:
๐ Burns
๐ Deep inflammatory acne
๐ Surgical wounds
๐ Tattoos
๐ Ear piercings
Early Wound Care
Proper care during the early stages can help reduce the risk of keloid formation.
Keeping the wound clean, preventing infection, and avoiding pulling, stretching, or excessive tension on the wound may lower the risk.
In contrast, slow healing, chronic inflammation, repeated irritation, rubbing, or friction from clothing may stimulate excessive scar formation.
Treatments That Can Improve the Appearance of Keloids
Although keloids can be difficult to eliminate completely, several treatments can reduce their size and improve their appearance.
Treatment usually begins with non-surgical or conservative methods, which may be effective for more than 95% of people with this type of scar.
Conservative Treatment
Silicone Gel Sheets
Silicone gel sheets may be applied approximately seven days after the wound has completely healed.
They should ideally be worn for up to 24 hours a day for around three months to:
๐ Maintain moisture
๐ Reduce inflammation
๐ Soften the scar
๐ Make the scar less noticeable
Microporous Tape
Microporous adhesive tape may be used instead of silicone sheets in some cases.
It helps maintain moisture, reduce inflammation, and reduce tension on the wound, which may help prevent raised scars.
Intralesional Steroid Injections
Triamcinolone acetonide is commonly injected directly into the scar to reduce inflammation and suppress excessive collagen production.
Treatment may begin as soon as the scar starts to show keloid characteristics, particularly within the first six months, when the response may be better.
Injections may be given once a month or according to the scar’s response to treatment.
Treatment Using Medical Technology
Laser Therapy
Lasers such as the Pulsed Dye Laser, or PDL, and fractional lasers may help reduce redness and make the scar flatter and smoother.
The laser works by targeting small blood vessels and stimulating skin repair.
Several treatment sessions may be required. Laser treatment is often combined with other methods, such as steroid injections, to improve the outcome.
Cryotherapy
Cryotherapy uses liquid nitrogen to freeze and destroy keloid tissue, allowing the scar to gradually become smaller.
The procedure may cause discomfort and usually needs to be repeated several times for the best result.
Surgical Treatment
Surgical Excision
Surgical removal is usually considered for large keloids or scars that have not responded to other treatments.
It may be combined with steroid injections or silicone sheets to reduce the risk of recurrence.
Serial Excision
Serial excision may be used for very large scars. The doctor gradually removes portions of the scar over several procedures to reduce its size in stages.
Dermabrasion
Dermabrasion may be used to smooth uneven scars, such as scars caused by inflammatory acne or chickenpox.
However, there is a risk of developing darker skin pigmentation after treatment.
Radiotherapy
Low-dose radiotherapy may be used after surgery to suppress collagen production and reduce the risk of the keloid returning.
It may be suitable for people with large scars or keloids that repeatedly recur.
Treatment may begin with silicone sheets, adhesive tape, or steroid injections. If these methods are not effective, laser therapy may be considered.
Surgery and radiotherapy are generally reserved for large scars or those that have not responded to other treatments. A combination of several treatments is often required to achieve the best result.
Can Keloids Return?
Keloids can recur after treatment. However, several measures may help reduce the chance of recurrence.
๐ Keep the wound clean and use prescribed treatments, such as topical medication or silicone sheets, to reduce inflammation and prevent raised scar formation.
๐ Avoid scratching, rubbing, or pressing firmly on the scar because repeated injury may stimulate further growth.
๐ Use pressure therapy or specially designed pressure garments to control scar-tissue formation. This may be suitable for large wounds, such as burns or scalds, and may need to be continued for six months to one year.
๐ Perform scar massage using appropriate pressure, sometimes together with scar cream or gel. Regular massage during the first three to six months after healing may improve circulation, soften the scar, and reduce further enlargement.
๐ Use steroid treatment when recommended by a doctor. In some cases, topical steroids may be used to support long-term scar control.
๐ Attend regular follow-up appointments. When a scar begins to show signs of returning, early treatment may help prevent it from becoming larger.
Reference :
Independent Writer
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