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

In the case that it is an elevated scar and invades healthy 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 responses to trauma. However, a keloid is an abnormal scar that grows beyond the boundaries of the original site of skin injury.

Keloids have the clinical look of an elevated amorphous growth and are frequently associated with pruritus and pain. Microscopy observation reveals randomly organized collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scarring, 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 reach a certain size and then stabilize or regress. Like keloids, hypertrophic scars are associated with negative wound healing factors.

There are no certain signs 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 genetics, 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 treatment approaches. The clinical course and physical look define keloids and hypertrophic scars as different lesions; however, they are often confused because of an apparent lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scarring and keloids have long been recognized by plastic surgeons and specialists. Yet, translating these differences into morphologic or biochemical signs has prompted much conflict in the literature. This report is an attempt to explain the longstanding discussion involving these 2 similar yet separate and nonidentical entities by explaining the reported points of individualization 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 evaluate for the first time the quality of life of patients with hypertrophic scarring and keloids, because they suffer from quality of life deprivation as much as patients with other chronic skin diseases. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to one hundred outpatients with keloids and hypertrophic scarring. A factor analysis was used to identify 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). 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 associated with pain and impediment of mobility, although the relationships were minor. This research 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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