Scars are a natural part of the healing process, but this process can sometimes go wrong. Some scars may become raised, thickened and more noticeable than normal. Two common types of raised, unusual-looking scars on the skin are keloids and hypertrophic scars. These are scars that may be bigger and more pronounced than the original wound. Although they may look similar, keloids and hypertrophic scars differ in their causes, appearance and treatment methods. It is important to understand the differences between keloids and hypertrophic scars to choose effective treatment options for their removal. In this article, we explore the differences between keloids and hypertrophic scars, what causes them and how to treat them.
What Are Keloids and What Causes Them?
A keloid is a type of raised scar that grows beyond the boundaries of the original skin injury. Unlike regular scars, keloids continue to grow even after the wound has healed, and they often become larger than the initial wound. They extend beyond the original wound, often forming irregular shapes. Typically, keloids appear as smooth, shiny, raised growths that are pink, red or dark brown. They can be itchy, painful or tender to the touch and may grow over time.
Keloids occur when there’s an overproduction of collagen during the healing process. While the exact cause is not clear, certain factors can increase the likelihood of developing a keloid:
- Genetics: People with a family history of keloids are more prone to developing them.
- Skin Type: People with darker skin tones, especially those of African, Asian or Hispanic origin, have a higher risk of keloid formation.
- Injury: Keloids can form from a variety of skin injuries. This includes acne scars, surgical incisions, burns, piercings, tattoos or even minor scratches.
- Age: Keloids are more likely to develop in individuals between the ages of 10 and 30.
What Are Hypertrophic Scars and What Causes Them?
A hypertrophic scar, on the other hand, is a raised scar that stays within the boundaries of the original wound. Whilst they may look like keloids, hypertrophic scars are more controlled in their growth and are often easier to treat. So whilst hypertrophic scars are raised and thick, unlike keloids, they do not extend beyond the borders of the original injury. These scars may appear red or pink at first but gradually fade over time. They are also usually less severe than keloids in terms of size and discomfort, though they can still cause itching or sensitivity.
Hypertrophic scars are similarly due to an overproduction of collagen, but unlike keloids, this process is more restrained. The main causes of these scars are:
- Injury: Hypertrophic scars can form from surgical wounds, cuts, burns or other types of skin trauma.
- Infection or Inflammation: In some cases, excessive inflammation during the healing process can contribute to hypertrophic scar formation.
- Skin Tension: Some areas of the body have skin that is tight or under tension, such as the joints or chest. These areas are more susceptible to hypertrophic scarring.
What’s the Difference Between Keloids and Hypertrophic Scars?
Although keloids and hypertrophic scars share some similarities, there are several key differences to keep in mind. Knowing how to tell them apart can affect your treatment choice:
| Characteristic | Keloids | Hypertrophic Scars |
|---|---|---|
| Growth | Extends beyond the original wound | Remains within the boundaries of the wound |
| Appearance | Smooth, shiny and often irregular in shape | Raised but more uniform in shape |
| Causes | Genetic predisposition, skin injuries | Skin tension, inflammation, injuries |
| Size | Can grow indefinitely over time | Gradually shrinks and flattens over time |
| Common Locations | Chest, shoulders, earlobes and cheeks | Chest, joints, back, shoulders |
| Skin Types | More common in darker skin tones | Can occur in all skin types |
| Discomfort | Can be itchy, painful or tender | May cause itching or sensitivity |
How Are Keloids Treated?
Treating keloids can be challenging, as they have a tendency to recur even after removal. However, there are several keloid treatment options that can help reduce the size and appearance of keloids. The most common ones include:
- Corticosteroid Injections: These are one of the most common treatments for keloids. Corticosteroid injections help reduce inflammation and collagen production, leading to a flattening of the keloid over time. You may need multiple treatments for optimal results.
- Surgical Removal: The procedure involves cutting off the scar tissue. However, keloid removal through surgery carries a risk of recurrence. The skin may form a new keloid in response to the incision. For this reason, doctors often combine surgery with other treatments like corticosteroid injections or radiation therapy.
- Laser Therapy: These treatments can help reduce the size and appearance of keloids by targeting the excess collagen. While laser therapy may not completely remove the keloid, it can significantly improve its appearance, especially when combined with other treatments.
- Cryotherapy: Freezing the keloid with liquid nitrogen can help shrink the scar tissue. This treatment is most effective for smaller keloids and often works best alongside other therapies.
- Radiation Therapy: In some cases, radiation therapy may be of use after surgical removal to prevent the keloid from growing back. This treatment is usually reserved for more severe cases where other treatments have failed.
- Silicone Gel Sheets: You can apply these to keloids to help flatten and soften the scar over time. Doctors often recommend this non-invasive option for early-stage keloids.
How Are Hypertrophic Scars Treated?
Hypertrophic scar treatment is generally more straightforward than keloid treatment, as these scars are less likely to recur or worsen over time. Some of the more effective treatments include:
- Corticosteroid Injections: Like with keloids, corticosteroid injections can help flatten hypertrophic scars by reducing inflammation and collagen production. Multiple sessions are often necessary.
- Silicone Gel Sheets or Gels: These silicone-based products are highly effective for hypertrophic scars. They can help reduce redness, flatten the scar and improve its texture. They are most useful as part of a longer-term management plan.
- Laser Therapy: This can help reduce the thickness and redness of hypertrophic scars. Doctors often use this therapy in combination with other treatments to improve the overall appearance of the scar.
- Pressure Therapy: Applying pressure to a hypertrophic scar, using pressure garments or bandages, can help flatten the scar over time. This method is particularly useful for scars on areas such as the chest or back.
- Surgical Removal: In cases where hypertrophic scars are particularly large or bothersome, surgical removal may be an option. However, this is typically reserved for more severe cases. Doctors may combine it with other treatments to prevent the scar from reforming.
How Do You Prevent Keloids and Hypertrophic Scars?
Prevention is usually the best approach when it comes to keloid and hypertrophic scar formation. Here are some tips to reduce the risk of getting these scars:
- Proper Wound Care: Keeping wounds clean and protected can reduce the likelihood of excessive scarring. Use pressure dressings or silicone sheets early on during the healing process.
- Avoid Unnecessary Trauma: Be mindful of unnecessary skin trauma, such as piercings or tattoos, especially if you are prone to keloids.
- Follow Post-Surgical Instructions: If you’ve undergone surgery, follow your doctor’s wound care instructions carefully to prevent hypertrophic scars.
- Monitor Healing: Pay attention to how your wounds are healing. If you notice excessive scar tissue forming, seek medical advice early.
Keloids and hypertrophic scars are often both cosmetically and physically troubling. The best approach is to try to avoid them. This is especially true if you are prone to them or have risk factors that increase their chances. Although they are notoriously hard to treat, there are several treatment options for keloid and hypertrophic scar removal. These may not work for everyone and recurrence is high. As such, it is important to seek medical help for these scars early. This will help you avoid them or, if that’s not possible, treat them adequately.
At City Skin Clinic, we are an online clinic. This means we do not offer in-clinic procedures like corticosteroid injections, surgery, laser or cryotherapy for keloids and hypertrophic scars. However, many people dealing with scarring also have acne scars and changes in skin tone, which respond well to topical treatment. Our doctors offer custom topical skin treatments using ingredients like tretinoin and azelaic acid where appropriate to support skin texture and tone. If you are interested in a personalised skincare treatment please use our online skin consultation form or book a video consultation. Start your treatment journey today and take your first step towards great skin.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical professional with any concerns about your skin or treatment options.
