Hypertrophic Scars – Keloids

About a scar

The word scar originates from the Greek word 'eskhara', which means scab. A scar is the body's natural way of healing and replacing damaged skin, usually composed of fibrous tissue.

Occurrence

• If the wound or injury is of partial thickness (i.e. it only involves the most superficial layers of the skin), it may heal without scarring but, if it is a full thickness wound (i.e. it involves the deeper layers of the skin), the skin heals with scarring.
• Scars may be formed for many different reasons, like infections, surgery, injuries or inflammation of tissue like after acne.
• Scars may appear anywhere on the body and the composition of a scar may vary, appearing flat, lumpy or sunken. They may be hypo pigmented (i.e lighter than the normal skin) or hyper pigmented (i.e. darker than the normal skin). Scars usually lose the normal skin markings.
• The final look of a scar depends on many factors such as, skin type, site on the body, direction of the wound, type of injury and age of the person.

Types

• Raised scars- Hypertrophic scars, Keloids
• Indented or depressed scars- Atrophic scars, like acne scars

Hypertrophic scars and keloids

Following a skin injury sometimes the wound heals with production of excess repair tissue i.e. collagen, which then gets deposited in these scars resulting in either a hypertrophic or a keloid scar.

• Hypertrophic scars – In hypertrophic scars the excess collagen is deposited within the borders of the original injury. They may be painful and itchy and can occur in any area of the body. These scars may also appear red, and are usually thick and elevated.
• Keloids – They tend to extend in a claw-like fashion beyond the border of the original injury, becoming more itchy over time. These are thick, rounded, irregular clusters of scar tissue that often appear red or darker in colour as compared to the surrounding normal skin. They occur more often in darker-skinned people. They can occur anywhere but are commonly seen on the chest, earlobes, shoulders, upper back.
• Hypertrophic scars tend to regress in time becoming flatter and smoother however keloids may continue to expand in size for decades.

Treatments

Treatments for keloids and hypertrophic scars vary. There is no one simple cure and recurrence after treatment is often documented. Treatment may include the following

• Creams and lotions – Topical creams or gels containing steroid or silicon can be used that help flatten keloids and hypertrophic scars. But they will not completely disappear. Therefore, they are used in combination treatment with various other treatments.
• Steroid injections – Steroids such as Triamcinolone acetonide are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations and also decrease the size of the scar. A series of injections is usually required to gain the maximal effect – generally given at 2-3 week intervals.
• 5-Flurouracil injections (5-FU) – 5-FU acts on the fibroblasts in the scar tissue, thus preventing them from making new scar tissue. These are often used in combination with steroid injections.
• Laser treatment – Lasers such as Pulsed dye laser or even erbium yag may act on these scars. They are attracted towards the haemoglobin (i.e. blood) content of the scars and close the blood vessels and reduce the redness as well as the thickness of the scars.
• Pressure therapy – Pressure therapy involves a type of pressure bandage worn over the area of the scar. These may be worn day and night for 4-6 months.