My skin keloids.

I hear this all the time from patients, warning me that they tend to scar badly.  But what, exactly, is a keloid?  

keloid resulting from an ear piercing

Keloid (photo credit: emedicine.com)

 

hypertrophic scar

Hypertrophic scar  (photo credit: emedicine.com)

 

The image to the left is a keloid resulting from an ear piercing.

 

 

 

 

 

The image to the right is a hypertrophic scar.  Granted, it’s a pretty bad scar, but it’s intrinsically different from a keloid.

 

 

 

 

So what is the difference between a keloid and hypertrophic scar?

  • Hypertrophic scars are scars that thicken and raise up as they heal.   They may be red and itchy, and often they get better with time.
  • Keloids will continue to grow past the boundaries of the original scar (as in the photo above), and keloids do not get better with time.
  • Hypertrophic scars can form on anyone.
  • Keloids are more common in darker skinned individuals.

Why does this difference matter?

  • Hypertrophic scars are very common over the chest, shoulders, arms and legs, even in individuals who heal well elsewhere. This last point is important: just because you have a bad scar over your chest or shoulders does not mean that you form bad scars in general.
  • If you have a tendency to keloid, you can form keloids anywhere, and from anything.  Even something as simple as a bad acne breakout can start a keloid forming.
  • Treating hypertrophic scars may involve steroid injections, laser therapy, or silicone sheeting.
  • Keloids are much harder to treat because they tend to come back: up to 80% of keloids will recur after removal.  Treatment may even require radiation therapy to help prevent recurrence.

So you can see that keloids and hypertrophic scars actually behave very differently.  Just because you have formed hypertrophic scar in the past, does not mean you will scar badly in the future.  A history of keloids, however, does make you more prone to keloids in the future.  Finally, keloids are much more difficult to treat than hypertrophic scars.

If you think you have a tendency to keloid, I recommend seeing a Plastic Surgeon for an accurate diagnosis.  He or she will also be able to recommend treatment for the scars you already have, and ways to help prevent them in the future.

Greer Plastic Surgery