Cutaneous scars usually occur at sites of injury and can vary in appearance depending on the type, size, and anatomic location of injury, as well as genetic factors. People with skin of color are more likely than others to develop scars that are raised above the skin surface that are called hypertrophic scars or keloids.
Hypertrophic scars and keloids represent an over-production of collagen in the skin. The cause for this over-production is not completely understood, but genetic factors may play a key role. As hypertrophic scars or keloids occur at sites of injury, avoiding unnecessary trauma to the skin (e.g. from piercings, tattoos, or cosmetic surgery) is important for those prone to develop these types of scars (e.g. those who have a personal or family history of keloids). Some cutaneous injuries may produce both hypertrophic scars and keloids.
Hypertrophic scars are raised lesions that are confined to the area of cutaneous injury, whereas keloids extend beyond the boundaries of the initial injury and can grow to considerable sizes. Both types of scars may be found at sites of surgical incisions, cuts, or burns. They can also occur at sites of inflammation secondary to severe acne. Keloids may have associated symptoms, including itching, tenderness, or burning, and less commonly, pain.
Treatment of hypertrophic scars and keloids can be challenging. However, a range of treatment options are available. Treatments include: corticosteroid injections, surgical removal, laser therapy, radiation therapy, pressure earrings or garments, silicone gel or sheeting, and interferon injections. The specific type of treatment selected depends on the size, location, and severity of the keloid or hypertrophic scar, as well as the individual’s medical history. Surgical excision of keloids is associated with a high risk of recurrence since the surgery itself is a source of skin trauma. When surgical removal is chosen as a treatment option, it should be combined with one or more of the other treatments mentioned above rather than as a mono-therapy. Application of the topical medication, imiquimod, can reduce the risk of recurrence of keloids after surgical removal. Regular follow-up by the patient with a dermatologist is suggested.