Hypertrophic scars and keloids are exuberant fibrous repair tissues after a cutaneous injury. A hypertrophic scar remains confined to the site of original injury; a keloid, however, extends beyond this site, often with clawlike extensions. May be cosmetically very unsightly and pose a serious problem for the patient if the lesion is large and on the ear or face.
Causes of Hypertrophic Scars and Keloid
No specific gene or set of genes has been identified as allowing keloids to develop; however, the increased prevalence of keloids paralleling increased cutaneous pigmentation suggests a genetic basis or, at least, a genetic linkage. Trauma to the skin, both physical (eg, earlobe piercing, surgery) and pathological (eg, acne, chickenpox), is the primary cause identified for developing keloids.
Symptoms of Hypertrophic Scars and Keloid
Symptoms include pigmentation of the skin, itchiness, redness, unusual sensations and pain.
Diagnosis
Clinical diagnosis; biopsy not warranted unless there is clinical doubt, because another biopsy may induce new hypertrophic scarring.
Treatment
This is a real challenge, as no treatment is highly effective. Possibly, methods that induce collagenase will be forthcoming; UVA-1 (340 to 400 nm) is said to be effective by this mechanism.
Prevention Individuals prone to hypertrophic scars or keloids should be advised to avoid cosmetic procedures such as ear piercing.
Intralesional Glucocorticoids Intralesional injection of triamcinolone acetonide (10 to 40 mg/mL) every month may reduce pruritus or sensitivity of lesion, as well as reduce its volume and flatten it. This works quite well in small hypertrophic scars, such as occur with acne, but less well in keloids.
Combined Cryotherapy and Intralesional Triamcinolone The lesion is initially frozen with liquid nitrogen spray, allowed to thaw for 15 min, and then injected with triamcinolone acetonide(10 to 40 mg/ml). After freezing, the lesion becomes edematous and is much easier to inject.
Surgical Excision Lesions that are excised surgically often recur larger than the original lesion. Excision with immediate postsurgical radiotherapy is beneficial.
Silicone Cream and Silicone Gel Sheet Reported to be beneficial in keloids and is painless and noninvasive.
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