Keloid / Hypertrophic Scarring
What are keloid and hypertrophic scars?
Keloid and hypertrophic scars result from an abnormal wound healing response in particular individuals. They are the body's response to trauma, inflammation, surgery or burns, and sometimes can occur spontaneously. Common skin injuries that lead to keloid growth are; surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites, burns, acne, chicken pox, folliculitis/ingrown hairs, and shingles. Their appearance is of a raised, often red/purple coloured scar that can have a firm consistency.
The difference between keloid and hypertrophic scars is difficult to determine at times. Keloid scars tend to extend from the boundary of the original wound and do not regress, whereas hypertrophic scars tend to not extend from the original would and regress over time.
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Table: Differences between keloid and hypertrophic scarring
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Hypertrophic scars |
Keloid scars |
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Develop soon after injury |
May have delayed development after injury |
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Subside with time |
Rarely subside with time |
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Limited boundary |
Overgrows wound boundary |
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Size proportional to injury |
Minor injury may produce a large scar |
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Occurs across areas of motion/tension |
Occurs in any areas |
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Improve with surgery |
Often worsened by surgery |
What factors predispose to keloid or hypertrophic scarring?
Keloid and hypertrophic scarring is more common in darker skin. Hypertrophic scarring is more common than keloid scarring.
Increased skin tension or wound tension can also predispose to hypertrophic and keloid scarring. Keloids tend to develop more readily after puberty, and are more common in younger individuals rather than older individuals due to the greater tension of younger skin that predisposes to increased scarring.
Darker parts of the skin are more predisposed to keloid or hypertrophic scarring, thus the palms and souls of feet are rare places for keloids to form.
How can I treat hypertrophic and keloid scarring?
Retinoids - Topical retinoids are derivatives of Vitamin A that can be used in the treatment of keloid or hypertrophic scarring. Examples of topical retinoids include; Define, Refine 4%, Refine 8%, Refine MD (from Cosmedix), Bio-oil (a product that contains retinols), and Retin-A. Clinical studies have shown improvements after 12 weeks. The results from this treatment are generally not dramatic.
Corticosteroids - Corticosteroid creams and injections (including triamcinolone acetonide) are a common treatment modality for keloid scarring. Although, they do not make keloids disappear, they can help to flatten and provide symptomatic relief. A series of injections is usually required to gain the maximal effect - usually at 2 - 3 week intervals.
Surgery - surgical excision of a keloid scar can cause production of a larger keloid scar at times. Combining surgery with corticosteroid injections and external pressure can help reduce the recurrence rate. Surgery is generally not the treatment of choice with keloid scars.
Laser treatment - lasers can be used to help reduce the appearance of pigmented hypertrophic or keloid scars. This can be used in conjunction with corticosteroid injections.
Examples of these lasers include the Medlite q-switched Nd:YAG laser and the pulsed-dye laser.
Topical silicone gel - Topical silicone gel sheeting is a new and painless method to treat hypertrophic and keloid scars. Although the actual mode of action is unknown, it is hypothesised that it could be due to hydration of the skin from the silicone stimulates new collagen production. Usually treatment can commence once the skin is healed over (no open wounds), and that 2 months of wear is adequate for the prevention and treatment of hypertrophic and keloid scars. Examples of silicone gels include Dermatix.
Pressure garments - are particularly useful to help prevent scarring after burns. Collagen maturation is hastened and the scar flattens. The garments must however be worn for at least 9 months day and night in order to prevent the scars from forming, as well as be tight enough to provide adequate pressure.
Case study
This is a female who had a belly button piercing that caused keloid scarring. The treatment shows the result three months after one injection with triamcinolone (corticosteroid injection).
Why should I choose The Victorian Cosmetic Institute to treat my hypertrophic/keloid scars?
At The Victorian Cosmetic Institute, we have both plastic surgeons and cosmetic physicians that will be able to look at surgical and non-surgical (including laser) treatment of scars.
The first step is simply contacting us. We will then discuss with you what is a realistic and achievable outcome, and what to expect from your scar treatment.
Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.
It's as easy as clicking either of the buttons below and completing the provided form.
Otherwise, you can phone us directly on (03) 8850 0655 (Templestowe) or (03) 9707 0888 (Berwick).
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