There are five general categories of keloid scars: widening keloid, atrophic keloid, contracture keloid, hyperplastic keloid and keloid.
The following is a brief description of the categories.
1. Widening scar.
This type of scar is usually formed when the surgical incision is slowly widened from the initial linear one, usually seen 3 weeks after surgery. The scar is soft, light-colored, flat and without abnormal sensation such as pain and itching.
It does not thicken and bulge or form nodules, which clearly distinguishes it from a hyperplastic scar.
It is a relatively good outcome scar and generally does not require treatment unless the scar is in an exposed area, such as the face, neck and forearm.
Figure 1. A: widening scar; B: hyperplastic scar.
2. Atrophic scar.
This type of scar is flat and partly below the surrounding normal skin. They are usually small, round and depressed in the center. Most of the scars after acne and chicken pox belong to this category.
This type of scar can be treated if it is on the face and affects the aesthetics.
Figure 2: Atrophic scar, which we often call “acne pits”.
3. Contracture scar.
A scar that crosses vertically over a joint or skin fold usually shortens and is called a contracture scar.
The scar is usually hard, red, raised and painful; most importantly, it restricts the normal movement of the body and puts the limb in a forced abnormal position, which is often referred to as “dysfunction” by doctors.
Most of the post-burn scars on joints and depressed areas of the body are of this type, such as the neck, elbow, armpit, fingers, and wrist.
This type of scar affects function, especially the growth and development of children, and must be treated promptly.
Figure 3. contracture scar of the wrist.
4. Proliferative scar is a raised scar that is confined to the original injury area and can usually fade on its own.
The scar is hard, red, elevated, and painful, and most post-burn scars located on the trunk and extremities fall into this category.
These scars tend to fade on their own after one year and can be left untreated. If the pain and itching is severe, non-surgical treatment is possible. If surgical treatment is considered, it is best to wait one year after the onset of the disease.
Figure 4. This is a very interesting figure. The same area of keloid is of three different types. a: widening keloid, b: hyperplastic keloid, and c: keloid. Please note their different manifestations and the difference between each other.
5. A keloid is a raised scar that extends beyond the original injury, continues to grow and does not fade on its own.
They are hard, red, raised, painful and itchy and are found in specific areas such as the earlobes, forehead and outer upper arms. 10-30 years old is the age of high incidence, in addition, the growth of keloids accelerates during puberty and pregnancy.
It is important to note that it is difficult to make a diagnosis of keloid within one year of onset, as it usually behaves similarly to a proliferative scar at this time. However, if the scar does not tend to fade after one year, then a keloid is very likely.
In addition, keloid scars have many characteristics, such as the fact that only humans develop keloid scars and not other species, and the fact that keloid scars are most often seen in people with dark skin tones.
If a keloid is diagnosed, treatment is required, but note that simple surgical excision followed by suturing will mostly recur. The treatment of keloids is a complex, long-term and difficult process.
Figure 5. Keloid in the ear. Keloid scars are most often seen in the following cases: after ear lobe piercing of the ear eye, after preventive vaccination of the upper arm, and after acne on the forehead.