When a scar is thickened, it does not invade normal tissue and lies across the normal skin tension lines (creases in the skin). This type of scar falls into the 'hypertrophic' category.

In the case that it is a raised scar and invades normal tissue, then it is called a keloid scar. All kinds of scarring can occur on different areas of the skin, but some areas like the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are atypical reactions 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 look of a raised amorphous growth and are frequently linked with pruritus and pain. Microscopy observation shows randomly organized collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scars, the collagen bundles are arranged parallel to the skin surface.

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

There are no particular characteristics that can indicate what will be the ultimate look of a scar or what type 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 excessive scarring observed clinically that need different therapeutic approaches. The clinical course and physical look define keloids and hypertrophic scars as different entities; however, they are usually confused because of an apparent absence of morphologic differences. Nevertheless, clinical differences between hypertrophic scars and keloids have long been recognized by plastic surgeons and specialists. Yet, translating these differences into morphologic or biochemical distinctions has created much conflict in the literature. The present report is an attempt to explain the longstanding discussion regarding these 2 similar yet individual 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 are chronic disfiguring dermatoses with a strong resistance to treatment. The objective of our study was to evaluate 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 made modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. The questionnaire was given 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 nine and five items, respectively, were used. Test-retest reliability of the questionnaire was optimal (corr>0.9). High validity was proposed 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 impediment of mobility (P less than 0.001). The psychological scale was linked with pain and impediment of mobility, although the correlations were minor. This study demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.

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