Keloid scars include keloids, hyperplastic keloids and atrophic keloids.
Treatment is divided into surgical and non-surgical treatments.
Surgical treatment includes excision and suturing, skin grafting, flap transfer, soft tissue expansion, and machine grinding.
Non-surgical treatment includes compression therapy, drug injection therapy, radiation therapy, cryotherapy, biological therapy, etc.
Clinically, keloid scars are divided into the following types, each with different clinical manifestations and consequences, and different treatment methods.
(1) Superficial scar: Mostly seen after skin abrasions, superficial infections or superficial burns. These scars are rough in appearance and sometimes have pigmentation changes, but are locally flat and soft, without functional impairment, and gradually become less obvious after time.
(2) Linear (cord-like) scar: It is common after the healing of trauma or surgical incision, and can form a proliferative scar in serious cases. This kind of scar not only causes defects in appearance, but also sometimes causes dysfunction due to linear scar contracture.
(3) Webbed scar: The scar is wrinkled and resembles a duck web, so it is called webbed scar. These scars are usually found on the flexors of the joints, but also on the openings of tubular organs on the body surface, such as the corners of the mouth, nostrils, urethra, vaginal opening, etc. In the joint area, the scar will contract and cause joint flexion deformity, gradually forming a wrinkled wall and becoming a web-like scar.
(4) Depressed scar: A scar with a surface significantly lower than the surrounding normal skin and showing a depressed deformity is called a depressed scar. A depressed scar can be caused by healing trauma to the skin, subcutaneous tissues or deep tissues, or it can be caused by a severe septic infection of the soft tissue of the skin. If the defect is limited to skin and subcutaneous tissues, the depression deformity is shallow and mostly has only cosmetic effects without functional impairment. Defects involving deep tissues such as muscle or bone are often associated with functional impairment and require surgical repair.
(5) Atrophic scar: The appearance is mostly flat, flush with the surrounding skin surface or slightly lower. The surface is smooth and shiny, with some hypopigmentation appearing pale, some pigmentation appearing dark brown, and some pale and dark brown appearing in the same area. The texture is tough and soft, the base is loose and can be lifted and pinched. These scars are mostly found on the face and chest and back, and are generally stable, do not cause functional disorders and do not require surgery.
(6) Bridge-shaped scar: The two ends of the scar are connected to the normal skin by the tip, and the lower channel is separated from the base, shaped like a bridge, called bridge-shaped scar. It is mostly seen in the eyelid, lower collar, anterior neck and axilla. The scar is generally short and rarely associated with dysfunction, but the local unevenness is an obstacle to the appearance, and it is difficult to clean the area and often causes infection, so surgery is often required. It is only later that degenerative changes occur gradually.
(7) Keloid scar: It is a scar characterized by persistent hyperplasia. It often appears as a crabfoot-like infiltration into the surrounding healthy skin. The lesion is raised above the normal skin, with an uneven, irregular shape and a tough, itchy texture. It is very prone to recurrence after surgical excision.