Therapy of keloid and hypertrophic scars: a review
Ahmed Samir Edriss
Received: 27 October 2010 / Accepted: 19 May 2011 / Published online: 1 July 2011
Abstract Scar management for the prevention of excessive
scar formation has always been important but never so
important as it is today. Optimal management continues to
be an enigma for surgeons, and the best modality of treatment
has been debated for many years. However, most studies have
unfortunately been either retrospective or case report descrip-
tions. Advances in scar management have been hampered by
confusing or ambiguous terminology. There is no consensus
on what amount of posttraumatic skin scar formation is
“normal” and what should be considered “hypertrophic.” In
the World Health Organization's ICD-9, there is no
diagnostic code for hypertrophic scar—only keloid is listed
(Roseborough et al. J Natl Med Assoc 96(1):108–116, 2004).
Yet the medical and scientific literature distinguishes them as
different conditions. This confusion results in inappropriate
management of scar formation, and occasionally contributes
to decision-making related to elective or cosmetic surgery.
Our experience suggests that there is no single treatment for
scars that is adequate and that clinical judgment is very
important when considering treatment and balancing the
potential benefits of the various treatments available. The
goal of treating scars is to restore function, provide relief of
symptoms, enhance appearance, and prevent recurrence.
This article is based on our scientific and clinical experiences
and it focuses on over-the-counter options to manage keloid
and hypertrophic scars.
Keywords Wound healing
Scars are a result of the natural healing process that occurs
when the skin repairs itself after wounds, trauma, burns,
surgical incision, or disease . Normal skin tissue is
replaced with scar tissue to close open wounds and to prevent
infection. Scars can be painful, cause itching, and limit mobility.
Many scars are primarily a cosmetic concern, but their presence
may have a significant negative impact on the affected
individual's self-esteem. Consequently, patients often seek
treatment to reduce the appearance and discomfort of a scar.
There are several types of scars, two of the commonest
being hypertrophic and keloid scars. In the medical
literature, a hypertrophic scar is generally described as an
overgrowth of scar tissue that remains within the bound-
aries of a wound . The wound boundary shrinks as more
scar tissue forms. Currently, no objective diagnostic criteria
have been formulated to indicate when a scar can be
considered hypertrophic. Keloid scars are densely collage-
nous, nonencapsulated, benign connective tissue neoplasms.
The size and shape of keloid scars have little correlation with
the extent of the skin wound. Large disfiguring tumours often
result from minimal skin trauma. Keloid scars, unlike
hypertrophic scars, have a genetic etiology.
A commonly taught but confusing concept is that keloids
can be distinguished from hypertrophic scars by the
extension of the scar beyond the wound border . This
concept implies that a scar starts out as a hypertrophic scar
and later becomes a keloid, when it has exceeded some
vaguely defined wound boundary. Such a classification
scheme sets the stage for confusion, particularly when one
of the disorders is classified as an inheritable disease.
Scientists investigating pathological scarring suggest that
there are significant phenotypic differences between hyper-
trophic and keloid scars that may not be clinically obvious
A. S. Edriss (*)
Department of Plastic and Reconstructive Surgery,
Charles University Hospital Bulovka,
18001, Prague, Czech Republic
Eur J Plast Surg (2011) 34:425–436