Keloids & Hypertrophic Scars
Keloids and hypertrophic scars are two chronic skin conditions that result from abnormal wound healing after injury, surgery, burns or severe inflammatory acne. Unlike atrophic scars, where tissue is lost and leaves a depression, keloids and hypertrophic scars are caused by an overgrowth of fibrous tissue and fibroblasts, forming raised areas above the surrounding skin.
Treating these scars well requires a solid understanding of how they form. If a scar is simply cut out without a plan to control fibroblast activity, it is very likely to come back larger than before. At Haute-Derma, treatment is built on three principles: suppress fibroblast overgrowth, control inflammation at several levels and combine multiple treatment methods, so that scars become flatter and softer and the chance of recurrence is kept as low as possible.
How Keloids and Hypertrophic Scars Form
Normal wound healing winds down once collagen production is balanced by collagen breakdown. In people prone to keloids or hypertrophic scars, that balance is lost:
- Hypertrophic scars: These usually follow a deep injury to the dermis. Fibroblasts multiply actively but stay within the original wound edges. Hypertrophic scars tend to improve on their own, fading and flattening over a long period (1–2 years).
- Keloids: A true fibroproliferative disorder. Ongoing stimulation by pro-inflammatory cytokines and growth factors, especially TGF-beta, keeps fibroblasts multiplying vigorously so the scar spreads beyond the original wound. Keloids do not shrink on their own and often itch, burn, feel tight or ache.
Clinical Comparison: Hypertrophic Scars vs. Keloids
| Feature | Hypertrophic Scars | Keloids |
|---|---|---|
| Borders | Stay within the original wound. | Spread beyond the original wound. |
| Natural course | May flatten and soften gradually over a long period. | Do not regress; tend to grow larger over time. |
| Common sites | Any area of skin under mechanical tension. | Chest, shoulders, back, earlobes, neck, chin. |
| Symptoms | Little itching; occasional mild tightness. | Frequent itching, aching and tenderness to touch. |
| Treatment response and recurrence | Respond well to single treatments; low recurrence rate. | Need a complex combination approach; high recurrence if simply excised. |
Diagnosis and Assessment at Haute-Derma
Before starting any treatment, a Haute-Derma dermatologist examines the scar carefully to establish exactly what type it is:
- History and predisposition: We review family history, how long the scar has been present and any itching or burning, to gauge how active the fibroblasts are.
- Shape and borders: We define the edges of the scar clearly to plan either localized or more extensive treatment.
- An individualized plan: We choose the methods best suited to each scar to get the most from treatment and keep the risk of recurrence as low as possible.
Combination Treatment at Haute-Derma
Because keloids and hypertrophic scars are complex, Haute-Derma combines several methods within one course of treatment:
- Intralesional injection: Anti-inflammatory agents (such as a standard dose of corticosteroid, alone or with a fibroblast-suppressing agent) are injected directly into the scar every 3–4 weeks. This halts excess collagen production and quickly flattens and softens the scar tissue.
- Energy-based devices (fractional laser / pulsed dye laser): Specific wavelengths target the small blood vessels feeding the scar, reducing redness and cutting off the supply that fuels fibrous growth.
- Pressure therapy and medical silicone: Dedicated products keep steady pressure on the scar after treatment, helping to prevent new vessel growth and renewed fibrosis.
