Classification of scar A. Mature scar: slight pigmentation changes, flat; B. Immature scar: red, sometimes painful and itchy, mildly prominent. Usually flattened with time, with slight pigmentation changes.
C. Linear proliferative scar (after surgical trauma): red, prominent, usually itchy, limited to the original trauma, usually occurs a few weeks after surgery. Can increase rapidly in size within 3-6 months and enter a recessionary phase after a stable period. Usually matures to a raised, cord-like appearance and takes up to 2 years to fully mature.
D. Extensive proliferative scarring (post-burn): extensive, red, raised, and occasionally itchy, within the burn area.
E. Small keloid: localized hyperplastic, itchy scar that extends to normal tissue; grows for more than 1 year and does not subside on its own; often recurs with simple surgical excision; may have genetic abnormalities, commonly in the ear F. Large keloid: large, prominent scar (>0.5 cm) that may be painful and itchy, extends to normal tissue; often due to microtrauma and continues to grow for several years, commonly on the jaw, forehead, back etc.
Mild hyperplastic keloid scars and keloids are still the most widely used treatment with a recurrence rate of about 50%. It is only suitable for smaller scars.
Combination therapy is recommended for severe keloids: surgical excision combined with radiotherapy is still the treatment option with a low recurrence rate, and radiotherapy is a good partner to surgery and is usually administered after surgery. Studies have shown that radiotherapy should generally be administered within 24 hours of surgery for about 5 consecutive sessions, with an average cure rate of 80% over 5 years. For patients who cannot receive radiotherapy, postoperative local injections can be considered to prevent recurrence.