Keloid (scar diathesis): Minor trauma to any part of the body can easily cause the growth of keloid scars, including keloids and proliferative keloids. It is inappropriate to conclude that a person is a keloid based on a single post-surgical scar.
Hypertrophic scar (HS) and keloid (K) are both types of dermatofibrotic disorders that share many similarities and are therefore often confused, when in fact they differ in terms of onset, pathological process, treatment options and prognosis. The difference between the two is often one of the questions on the postgraduate plastic surgery entrance exam.
Briefly, the differences between the two can generally be divided into: Pathogenesis: HS-surgery, burns, other deep dermal skin lesions; K-can be caused by obvious skin lesions or no obvious cause (acne, mosquito bites, etc.).
Pathology: HS- often related to more severe skin trauma, untidy surgical incisions, wound contamination, etc.; K- closely related to local inflammatory reactions of the skin, even without obvious causes.
Family history: HS-no obvious family history, but mostly related to the degree of skin damage; K-common family history, considered to be autosomal dominant.
Prevalent sites: HS-all areas of the body where the skin is damaged; K-areas of high skin tension such as the chest, shoulders, outer upper arms, and earlobes.
Solitary multiple occurrences: HS-occurring at the place of injury; K-often multiple occurrences for inexplicable reasons.
Morphology: HS-proliferates to a high level and the base is confined to the original injury boundary; K-exceeds the original injury boundary and may even increase indefinitely. During the proliferation process, it can infiltrate the surrounding normal skin and turn even normal skin into keloid, so it is also considered as a kind of skin tumor.
The growth pattern: HS-often shrinks and softens on its own after several years; K-slowly or rapidly expands in all directions (usually in the direction of skin tension) transforming the surrounding skin into keloid skin while the central part of the scar may gradually shrink.
Symptoms: HS- painful and itchy symptoms may be very pronounced; K- often may be asymptomatic, with occasional painful and milder itching.
Treatment: HS-compression, hormone injection, radiotherapy are useful, and the recurrence rate is low. Surgical excision is feasible after scar atrophy, and the possibility of scar recurrence after surgery is small; K-all kinds of treatment have a very high recurrence rate, especially avoid performing simple surgical excision.
Complications: HS-no combination of lesions other than the scar itself; K-possible combination of fibroproliferative diseases in other organs of the body, such as liver, kidney fibrosis, uterine fibroids, etc.