KELOIDS AND HYPERTROPHIC SCARS

Keloids and hypertrophic scars occur in predisposed individuals following trauma, inflammation, surgery, or burns and occasionally they occur spontaneously. These fibrous growths are abundant depositions of collagen and glycoprotein. Early reports often included both keloids and hypertrophic scars from various anatomic sites. Such reports add confusion to a poorly understood wound response. Later reports distinguish keloids from hypertrophic scars in terms of extension beyond the original wound and clinical course. Hypertrophie scars typically remain within the confines of the original wounds and these raised scars often spontaneously regress. Hypertrophic scars occur soon after the antecedent trauma or inflammation. In general, the hypertrophic scar remains within the limit of the wound or inflammation and the lesion may increase in size or regress over months to years. Keloids occur in predisposed individuals and the enlarging lesions extend beyond the original wound and rarely regress.1 Individuals with severely disfiguring multiple keloids are more likely to have a family history of keloids, suggesting a genetic predisposition for this abnormal wound response. The cause of this abnormal wound response is unknown, but abnormal cellular responses may account for the abundant connective tissue deposition. These fibrous growths typically generate significant disfigurement and unwanted symptoms, such as pruritus or pain. Multiple treatment approaches have been reported and responses are highly variable. Therapy selection should be carefully matched to the individual and the abnormal wound response to obtain the best possible result. © 1994.