When a scar is engrossed, it doesn't invade healthy tissue and lies across the relaxed skin tension lines (creases in the skin). This type of scar falls into the 'hypertrophic' category.

In the case that it is a raised scar and invades healthy tissue, then it is called a keloid scar. All types of scarring can appear on different areas of the body, but some areas such as the chest, knees and elbows are more likely to scar.

Both keloid and hypertrophic scar tissues are uncommon reactions to damage. However, a keloid is an abnormal scar that grows beyond the limits of the original site of skin injury.

Keloids have the clinical appearance of a raised amorphous growth and are usually associated with pruritus and pain. Microscopy analysis reveals randomly disposed collagen fibers in a hard connective tissue matrix, making keloid removal a difficult task. In normal scarring, the collagen bundles are arranged parallel to the skin surface.

A hypertrophic scar is an engrossed or unsightly scar that does not grow beyond the original limits of the wound. Unlike keloids, scars caused by hypertrophic actinic keratosis reach a certain size and then stabilize or regress. Like keloids, hypertrophic scars are associated with adverse wound healing factors.

There are no particular characteristics that can reveal what will be the ultimate appearance of a scar or what kind of scar it will be. The way in which a wound cures is different for every person and is determined by genes, the environment and how you care for it.

Keloid or hypertrophic scar: A review of the literature

Atiyeh BS, Costagliola M, Hayek SN.

Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.

Keloid and hypertrophic scars are two types of exaggerated scarring observed clinically that require different treatment approaches. The clinical course and physical appearance define keloids and hypertrophic scars as separate entities; however, they are usually confused because of an apparent lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scarring and keloids have long been recognized by plastic surgeons and dermatologists. Yet, expressing these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. This report is an attempt to clarify the longstanding controversy regarding these 2 similar yet separate and nonidentical entities by highlighting the reported points of individualization as well as the similarities.

Quality of life of patients with keloid and hypertrophic scarring.

Bock O, Schmid-Ott G, Malewski P, Mrowietz U.

Primary Health Care Center, Halsan 2, Fabriksgatan 17, 55 185, Jonkoping, Sweden.

Keloid and hypertrophic scarring are chronic disfiguring dermatoses with a high resistance to treatment. The aim of our research was to evaluate for the first time the quality of life of people with hypertrophic scarring and keloids, because they suffer from quality of life deprivation as much as people with other chronic skin ailments. An item-pool was made modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was given to one hundred outpatients with keloids and hypertrophic scarring. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical deprivation) of the questionnaire with nine and five items, respectively, were established. Test-retest reliability of the questionnaire was excellent (corr>0.9). High validity was suggested by the correlation of physical deprivation with pain (P less or equal to 0.001), pruritus (P less than 0.001), and the proportion of impediment of mobility (P less than 0.001). The psychological scale was associated with pain and impediment of mobility, although the correlations were lower. This research demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.

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