When a scar is thickened, it doesn't invade healthy tissue and lies across the normal skin tension lines (creases in the skin). This kind of scar is referred to as hypertrophic.

In the case that it is a raised scar and invades healthy tissue, then it is called a keloid scar. All kinds of scarring can appear on different areas of the body, but some areas such as the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are atypical responses to trauma. However, a keloid is an aberrant scar that grows beyond the boundaries of the original site of skin damage.

Keloids have the clinical appearance of an elevated amorphous growth and are frequently linked with pruritus and pain. Microscopy observation reveals randomly disposed collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scars, the collagen bundles are disposed parallel to the skin surface.

A hypertrophic scar is an engrossed or unattractive scar that does not grow beyond the original boundaries of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis grow to a certain size and then stabilize or regress. Similar to keloids, hypertrophic scars are linked with adverse wound healing factors.

There are no certain signs that can reveal what will be the ultimate appearance of a scar or what kind of scar it will be. The way in which a wound cures is different for every individual and is determined by genes, the environment and how you care for it.

Keloid or hypertrophic scar: A review of the literature

Atiyeh BS, Costagliola M, Hayek SN.

Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Keloid and hypertrophic scars are two kinds of exaggerated scarring observed clinically that require different therapeutic approaches. The clinical signs and physical appearance define keloids and hypertrophic scars as different lesions; however, they are often confused because of an apparent lack of morphologic differences. Still, medical differences between hypertrophic scars and keloids have long been known by plastic surgeons and specialists. Yet, expressing these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. This report is an attempt to clarify the longstanding controversy regarding these 2 similar yet separate and nonidentical entities by highlighting the reported points of differentiation as well as the similarities.

Quality of life of patients with keloid and hypertrophic scarring.

Bock O, Schmid-Ott G, Malewski P, Mrowietz U.

Primary Health Care Center, Halsan 2, Fabriksgatan 17, 55 185, Jonkoping, Sweden.

Keloid and hypertrophic scarring represent chronic deforming dermatoses with a strong resistance to treatment. The aim of our research was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life deprivation as much as patients with other chronic skin ailments. An item-pool was created changing and complementing the items of the Questionnaire on Experience with Skin Complaints. The questionnaire was distributed to one hundred outpatients with keloids and hypertrophic scars. A factor analysis was used to recognize the underlying dimensions. Two scales (psychological and physical deprivation) of the questionnaire with 9 and 5 items, respectively, were established. Test-retest validity of the questionnaire was excellent (corr>0.9). Good validity was suggested by the correlation of physical deprivation with pain (P less or equal to 0.001), pruritus (P less than 0.001), and the proportion of restriction of mobility (P less than 0.001). The psychological scale was linked with pain and restriction of mobility, although the relationships were minor. This research demonstrates for the first time a deprivation of quality of life in a large group of sufferers with keloid and hypertrophic scars.

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