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Keloid vs. Hypertrophic Scar

How to Diagnose a Keloid or Hypertrophic Scar

There are similarities and differences between a hypertrophic scar and a keloid scar. Over the years, the classic differences between hypertrophic and keloid scars were mainly focused on morphology (or shape) of the scar, but newer research has demonstrated major differences in the behavior of these two scars, both from a clinical perspective as well as a molecular and cellular perspective. Dr. Raffy Karamanoukian has been involved in the treatment of keloid and hypertrophic scars for over a decade and has demonstrated his unique and effective approach on national television and national publications. He is an expert in scar treatment and can help you understand your scar so that we can better treat the condition. 


Hypertrophic scars usually occur at the site of skin injury (laceration, cut, surgical scar, burn) and are characterized by an overdeposition of scar collagen along the area of injury. In the case of a surgical incision, the body begins to deposit extra collagen to bridge the gap between the skin edges. Once the deposited collagen reaches a critical threshold, the 'scar' that develops begins to thicken and widen. Hypertrophic scars can be raised, widened, red, and painful.  It may take quite some time for a hypertrophic scar to settle down on its own, prompting scar experts to use a combination of lasers, injections, and topical scar gels (Plato's Scar Serum) to reduce the severity of the scar. Some hypertrophic scars will have underlying inflammatory phases, likening them to keloid scars. 

Keloid scars can also occur at sites of skin injury (cuts, scrapes, piercings, surgical incisions, and lacerations), but the body's response to the injury far outweighs the initial trauma. In other words, a keloid scar response is severely disproportionate to how much skin trauma occured. A perfect example of how disproportionate a keloid response is to the initial injury is an ear piercing. In this particular case, a single pin point piercing can initiate a scar response that leads to the development of a large keloid that can grow indefinitely. Keloids are caused by a combination of collagen deposition and inflammation, making a keloid grow in size and become painful. 


Q: Can children develop keloids and hypertrophic scars? A: Hypertrophic and keloid scarring does not discriminate based on age. Scientists are not completely sure what initiates a scar to progress into a hypertrophic or keloid scar, but these types of scars can occur in children and adults of all ages. The presence of abnormal scars on childrens presents a difficult problem for surgeons as many of the commonly used medicines and surgeries are avoided in children. Our office recommends early treatment for keloids in children and early application of Plato's Scar Serum to help smoothe and soften scars. 

Q: Can sun exposure aggravate a keloid or hypertrophic scar? A: UV exposure may have potential harmful effects on a hypertrophic or keloid scar. Often, these scars do not have normal levels of melanin, so they are more sensitized to sun exposure. Direct sunlight can aggravate a scar, making it more red and inflamed if the sunburn is severe enough. Our office advises avoidance of direct sun exposure on keloids and hypertrophic scars, followed by application of a sunscreen such as Plato's Dark Scar Corrector with SPF 30. 

Q: Can keloid scars cause pain? A: Keloids are active scars that can often become symptomatic, causing pain, itching, and burning. Little is known about the reasons behind keloid pain, but scientists believe that it is linked to the process of inflammation and histamine release. If you are having symptoms associated with your keloids, it may be time to have them treated with combination protocols that include lasers, injections, topical therapies, and scar modulation. 


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