When skin tissue becomes damaged, the body seeks to repair it by developing collagen, which creates a scar. Scars often reduce in size and become less visible as time progresses, but there are exceptions to this. A keloid or hypertrophic scar is a form of raised scar that most commonly occurs when a surgical incision or instance of acne has healed, and is characterised by a thick and lumpy texture. Unlike many other scars which tend to fade and become smaller over time, a keloid can actually become larger, continuing to grow for months or even years after the damaged tissue has fully healed.
Keloids and hypertrophic scars are prominent scars that protrude outwards from the surface of the skin. Keloids grow beyond the perimeter of the original site of the wound, while hypertrophic scars are confined to the site of the wound. While these scars have a smooth and glossy surface texture, they also have a thick and sturdy composition. They are most commonly brown, pink, red or skin-coloured. The size and shape of keloids varies greatly, and larger keloid scars can become a source of emotional discomfort for some.
The exact cause of keloid scars is not yet known. Not every patient who undergoes a surgical operation that results in a scar, will develop a keloid or hypertrophic scar. Such scars commonly arise due to an abnormally high buildup of collagen, in response to damage to skin tissue due to surgery, acne, burns, or body piercing. Unlike hypertrophic scars, keloids do not immediately appear after a wound has healed, and can take anywhere from 3 to 12 months or more to develop. The appearance of keloids or hypertrophic scars does not depend on the severity of a wound. Even minor wounds can cause a keloid or hypertrophic scar to form.
Keloid Scars | Hypertrophic Scars |
---|---|
Can take between 3 to 12 months to first appear | Occur shortly after wound appears |
Seldom become smaller or fade over time | Can get smaller and fade over time |
Grows beyond the site of the initial wound | Does not grow beyond perimeter of original wound |
Even a small wound can result in a significant scar | Is proportionate to size of wound |
Can appear on any part of the body | Typically forms in areas where skin is tight |
Can cause pain or itchiness as it grows larger | Typically do not cause pain or itchiness |
Condition can be made worse by surgical removal | Condition is improved with surgical removal |
Keloid scars can appear on all parts of the body, but they most commonly develop on the chest, shoulders, and around the face including the ears, cheeks, chin, and neck. While hypertrophic scars can appear on any area of the body, they often develop in taut skin areas.
Keloids and hypertrophic scars generally do not pose a direct health threat, but their appearance can be distressing, particularly if they are in an exposed location of the body. In some cases, keloids can also develop on top of a joint or expand over a significant area of skin, making movement more difficult.
A doctor can typically diagnose a keloid or hypertrophic scar simply by examining it. However, in some cases, another illness or condition may look similar to a keloid. In these instances, a doctor will carry out a skin biopsy, which is a simple process that is completed at your appointment. The biopsy involves taking a small skin sample and sending it to a medical laboratory for review. The sample is then examined under a microscope by a doctor, who creates a report and notifies the doctor of their findings. If it is determined to be a keloid or hypertrophic scar, your doctor will develop a treatment plan for you.
If you are susceptible to keloids, it is difficult to prevent further ones from occurring. However, there are ways to reduce the risk of keloid formation, by avoiding unnecessary procedures such as:
If you do require surgery, it is important that your doctor is made aware of your past history with keloids. With this knowledge, your doctor can take additional precautions to reduce the risk of keloid formation.
Cryotherapy: This involves the use of extremely cold temperatures to treat or eliminate keloid or hypertrophic scar tissue. Cryotherapy is a safe, effective and cost-efficient means of treating large sized keloids.
Steroid Injections: If a keloid or hypertrophic scar appears following surgery, doctors advise steroid injections into the scar tissue every 4 – 6 weeks, with a maximum of 5 injections. Steroid injections take approximately 15 minutes each, and no anaesthesia is necessary.
Pulsed Dye Laser – These lasers help to reduce the reddish colour that is often endemic to keloids and hypertrophic scars. The laser achieves this by eliminating the blood vessels contained within the scar tissue.
Surgical Excision – While still in use, surgical excision for keloids is seldom used, as this treatment method results in a high rate of recurrence. Combining the excision with steroid injections can lower the risk of recurrence. Hypertrophic scars on the other hand, typically do not reappear after surgical removal.
Silicone Creams – The application of topical silicone creams is a new method of treating keloid and hypertrophic scars and is entirely pain-free. While the reason behind the treatment’s effectiveness has yet to be fully understood, it is theorised that the cream’s ability to hydrate the skin of the affected area, triggers collagen generation.
Excision and Radiation Treatment – Radiation therapy can be used post-surgery, to help reduce the risk of keloid and hypertrophic scar recurrence. Research indicates that radiation therapy can significantly reduce recurrence rates. Radiation treatment is commenced 3 days after surgical excision of the scar tissue.
Shave Excision and Aldara Creams – Shave excision is used in combination with Aldara creams. Studies indicate that Aldara creams are an effective means of reducing recurrence rates for keloid and hypertrophic scars, following shave excision treatment.
If you believe that you may have a keloid or hypertrophic scar and wish to have it examined, arrange a consultation with one of our specialists today.