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Hypertrophic and Keloid Scarring

Author: Dr Naomi / 28 Oct 2015

What is a keloid scar?

A keloid scar is a type of raised scar that is caused by the overgrowth of granulation tissue (collagen type 3) at the site of a healing/healed skin injury, which is then replaced by collagen type 1.

In keloid scars the tissue feels firm and rubbery or is a shiny stretched nodule. Colours of keloid scarring can be skin coloured, white, red or brown. THey also may have a variety of colours. Keloids are often itchy and uncomfortable

What is a hypertrophic scar?

A hypertrophic scar is a raised scar that does not grow beyond the boundaries of the original wound (these are more common than keloid scars)

What causes a keloid scar?

  • Keloids form within scar tissue and may be caused by a scratch, a pimple, an insect bite, a burn or any skin trauma
  • They are caused by an overgrowth of collagen.
  • It is more common in highly pigmented people, including Africans
  • Infection in a wound site
  • Excessive tension during wound closure
  • A foreign body in a wound
  • Sometimes they can occur spontaneously
  • They are more common in some sites such as the central chest, upper arms, the back and shoulders and the ear lobes

Treatment of keloid / hypertrophic scars

Prevention:

is most important in those who are known to have a predisposition to keloid scarring. ie avoid unnecessary trauma or surgery, and treat skin problems early in patients who are predisposed to keloids (eg acne, infections

Intralesional injection of steroids:

This is the first line treatment of keloid scarring. Usually 3 treatments are required 1 month between treatments. Steps should be taken to reduce the risk of steroid atrophy when using this treatment.

Recurrences are common after this treatment

Excision:

Should be performed with pre/ intra / post operative triamcinolone or interferon  injections

Recurrences are common after this treatment

Silicon Gel Sheeting:

Can be used for treatment of symptoms including itch and pain and prevention of formation and treatment  of keloid after skin trauma

Cryosurgery

Is an option for treatment, but its main risk is of hypopigmentation, which is important to avoid in darker skinned people

Other treatments

Radiation Therapy, Pulsed Dye Laser, Ablative Laser, interferon injections, antiwrinkle injections

Cost of intralesional injection of steroid

Cost is $240, there may be a small medicare rebate for this procedure

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