Hypertrophic scar and keloid

SCARS are new formations caused by a reparative process due to the loss of skin substance of traumatic or pathological origin, affecting the dermis or hypodermis. In fact, the scarring process is nothing more than the healing of the skin through the formation of scar connective tissue, which, if produced in excess, can lead to a larger and more visible scar. Specifically, in hypertrophic scars and keloids, collagen and fibroblasts continue to multiply even after the wound has healed, leading to an excessive increase in its volume.

A scar can result from pustules (e.g., acne), vesicles (e.g., chickenpox), or blisters (cicatricial pemphigoid). In the early stages, it is often raised and red in color, but it tends to flatten over time, taking on a pearly white color.

Based on their morphological characteristics, scars can be classified as:

• Depressed (or atrophic)

• Raised (or hypertrophic)

• Exuberant with expansive evolution (or keloid)
  

The scarring process can be complicated by a series of events that, by affecting the skin, can lead to different clinical developments.

A HYPERTROPHIC SCAR can result from inappropriate treatment of a wound, such as a rough suturing procedure, excessive tension at the edges of the wound, or even due to a certain genetic predisposition of the individual. In the first few weeks, the scar appears as a raised, cord-like structure, usually accompanied by pain. Over time, hypertrophic scars tend to regress spontaneously, a process that, from a histological perspective, is explained by the reappearance of elastic fibers and the compacting of collagen fibers.

A KELOID is a hypertrophic process with a tendency to grow beyond the peripheral edges of the wound and to recur after surgical removal, often increasing in size each time. This is the feature that distinguishes it from a simple hypertrophic scar. The formation of a keloid is linked to both endogenous factors (such as racial predisposition in individuals with darker skin) and exogenous factors (such as excessive tension at the wound edges or other conditions that slow down healing). Additionally, there are specific areas of the body where, due to their structural characteristics, the likelihood of developing a keloid is particularly high (such as the sternum, back, neck, deltoid, and earlobe).

From an aesthetic perspective, a keloid appears as a bright red swelling of varying shapes and sizes, usually larger than the original lesion. In all cases, pain is present, both spontaneously and when pressure is applied.