This document discusses hypertrophic scars and keloids, types of abnormal scarring. [1] A hypertrophic scar remains within the boundaries of the original wound, while a keloid extends beyond the wound site. Keloids contain immature fibroblast cells and blood vessels. [2] Keloids are more common in certain races and more likely after repeated trauma or piercing injuries. The exact cause is unknown. [3] Keloids are treated with steroid injections, radiation therapy, or surgery, though recurrence is common after surgery. Complications include infection and potential malignant transformation.

1. VRANAGRANTHI
Dr. Alok Kumar
PhD Shalya Tantra
NEIAH Shillong

2. HYPERTROPHIC SCAR
• During the process of wound healing due to prolonged stage of maturation the
fibroblast over activity the scar becomes big but never crosses the original incision is
called hypertrophic scar. The tissue contain only fibrous tissue without blood
vessels.
• It is common in young individuals
• The incision against the natural crease of skin ( line of langer’s) are more prone to
develop hypertrophic scar.
• It usually have no sign of increased vascularity, itching and regresses after 6 months.
• It does not recurs after complete excision

4. KELOID
• This looks similar to hypertrophic
scar, usually followed after
trauma/scar formation.
• The distinguish feature of keloid is
that it extends beyond original
scar and affects normal tissue. The
tissue have immature fibroblast
cells with immature blood vessels.
It has claw like process.

5. •It present with severe
itching, tenderness and
develop sinus with
discharge if got secondary
infection.

6. ETIOLOGY
• Races like negroes are commonly affected other may also do
have.
• Usually have genetic predisposition
• Local irritant/ physical repeated trauma/piercing injury
precipitate the condition.
• More common in women than men
• Exact etiology is unknown

7. PATHOPHYSIOLOGY
• The basic pathology of keloid is
proliferation of immature fibroblast and
immature blood vessels around the base
of the sebaceous and sweat glands.
These cells gradually infiltrates in to
surrounding tissue and proliferates
continuously.
• Presence of plenty of immature blood
vessels causes pinkish in color.

8. TYPES
• According to mode of
origin
• Acquired
• Spontaneous
• According to character
of keloid
• Progressive
• Non-progressive
Acquired
ProgressiveNon-progressive
Spontaneous

9. CLINICAL FEATURE
• Common site is chest/midsternal.
• Followed scar of incision, burn or simple pin prick.
• Raised swelling from surface, Brown/ pinkish in color, smooth, claw like progression
beyond the original scar.
• Sever itching.
• May have discharge (serosanguineous) if get secondary infection and develop sinus
undersurface.

10. MANAGEMENT
• Conservative
• Symptomatic medication
• Intra-keloid injection of steroid, Hialuronidase, vitamin A or methotrexate.
• Deep X-Ray or ultrasonic therapy
• Surgical
• Only after explain prognosis.

11. COMPLICATION
• Recurrence
• Ulceration
• Secondary infection
• Undergoes malignant transformation.

14. HYPERTROPHIC SCAR VS KELOID