Many people have heard the word “keloid”, and think it means “any bad looking scar”. This is a common misconception. Scars fall into a couple of categories. Since different types of scars and scar problems are treated differently, it’s important to diagnose the scar situation accurately.
A keloidal scar is a scar that continues to enlarge and spreads beyond the borders of the initial wound. They are more common in African-American patients as well as Hispanics, Philipinos and Orientals, but can occur in patients of any race. Keloids often recur after excision, and do not tend to improve with time on their own. They are common on the face, earlobes and the chest. They are more common in women than men.
A hypertrophic scar may be thick, raised or reddish in color – but the key diagnostic difference is that they do not spread beyond the boundaries of the original wound. Most of the “bad scars” that patients show me are in this category. Hypertrophic scars may partially regress over time, becoming more flat and pale. They usually show up during the first few months after a surgical incision. They occur in equal frequency in both men and women.
A third type of scar, called a “wide-spread scar”, is also common. These are typically surgical incisions that remain flat, but widen out, like a stretch-mark. They do not have the ropey consistency of a hypertrophic scar. These scars have a normal amount of collagen in them (unlike keloids and hypertrophic scars). They typically have widened out from mechanical tension (pull) across the incision. These usually respond quite well to surgical re-excision.
Commonly used treatments for these abnormal scars can involve scar massage, pressure application, use of topical silicone sheeting or gel, use of steroid injections into the scar, in addition to various surgical excision methods. Since the recurrence rate with surgical excision alone in keloid scars is about 50%, surgical excision is usually combined with one or more of the other listed techniques.
We’ll discuss more about surgical scar revision in future chapters of the blog.