When a scar is thickened, it doesn't 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 appear on different areas of the body, 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 abnormal scar that grows beyond the boundaries of the original site of skin injury.

Keloids have the clinical look of a raised amorphous growth and are usually associated with pruritus and pain. Microscopy analysis reveals 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 an engrossed or unsightly scar that does not extend beyond the original boundaries of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis grow to a certain size and then stabilize or regress. Like keloids, hypertrophic scars are associated with negative wound healing factors.

There are no particular characteristics that can reveal what will be the ultimate look of a scar or what kind of scar it will be. The way in which a wound heals is different for every person 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 excessive scarring observed clinically that require different therapeutic approaches. The clinical course and physical look define keloids and hypertrophic scars as separate lesions; however, they are often confused because of an apparent absence of morphologic differences. Still, medical differences between hypertrophic scars and keloids have long been recognized by plastic surgeons and dermatologists. Yet, translating these differences into morphologic or biochemical distinctions has created much conflict in the literature. This report is an attempt to explain the longstanding controversy 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 high resistance to therapy. The aim of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin ailments. An item-pool was created 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 impairment) of the questionnaire with 9 and 5 items, respectively, were used. Test-retest validity of the questionnaire was excellent (corr>0.9). High validity was suggested by the correlation of physical impairment with pain (P less or equal to 0.001), pruritus (P less than 0.001), and the amount of restriction of mobility (P less than 0.001). The psychological scale was associated with pain and restriction of mobility, although the relationships were lower. This study shows 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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