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What Are Keloids and Hypertrophic Scars?
When your skin heals after a deep cut, surgery, or acne, it sometimes creates thick, raised scars. These scars come in two main types:
- Hypertrophic Scars: These stay within the wound’s area and usually improve over time.
- Keloids: These grow beyond the wound and can keep getting worse.
Keloids and hypertrophic scars happen because the body makes too much collagen (a protein in the skin) while healing. Some people, like those with Asian or African heritage, are more likely to get these scars.
Why Are They Hard to Treat?
Doctors have struggled to find clear ways to treat these scars because:
- Keloids and hypertrophic scars can look similar, making diagnosis tricky.
- Research has been slow because it’s hard to study these scars in animals.
- There hasn’t been a consistent guideline to help doctors choose the best treatments.
How Are These Scars Diagnosed?
The Japan Scar Workshop (JSW) created a tool called the JSW Scar Scale (JSS). This tool gives a score based on how severe the scar looks and the patient’s risk factors. Doctors use this score to figure out the type of scar:
- Score of 5 or less: Normal scars
- Score 6–15: Likely hypertrophic scars
- Score 16 or higher: Likely keloids
Doctors may also check the scar under a microscope or use imaging to confirm the diagnosis. Sometimes, they do a biopsy (taking a small piece of tissue) to ensure the scar isn’t something more serious, like a skin tumor.
How Are They Treated?
The treatment depends on the type of scar and its location. The JSW created a guide to help doctors pick treatments. Some common methods include:
- Medications:
- Steroid creams or injections to reduce swelling.
- Silicone gels or sheets to flatten the scar.
- Special pills that may help with inflammation.
- Physical Methods:
- Compression therapy (tight bandages or garments).
- Taping or resting the area to reduce skin tension.
- Surgery:
- Cutting out the scar, sometimes followed by radiation or skin grafts to prevent it from coming back.
- Other Options:
- Laser treatments to improve appearance.
- Cryotherapy (freezing the scar).
- Injections like Botox or certain drugs to stop scar growth.
Why Does Location Matter?
Scars in certain areas, like the chest, shoulders, or joints, are harder to treat because the skin moves a lot there. The JSW created specific plans for treating scars in different body parts.
What’s Next?
Scientists still need to study these scars more. For example, they’re trying to find biomarkers (signs in your body) that can easily tell keloids and hypertrophic scars apart. Better research will help doctors treat these scars more effectively in the future.