Instant gratification comes with each treatment because you can kind of see it start to chip away and disappear.
Dr. Waibel was given the honor of being named “Person of the Week” on ABC World News Tonight with David Muir.
Among the most common scar types, hypertrophic scars initially appear as raised, red scars that, by definition, do not extend beyond the site of the original injury. Their name comes from the fact that they stem from excess (hyper) growth of collagen. Hypertrophic scars share many of the same underlying causes as keloids (see next section), and generally the same treatments work for both types of scars. Usually burn and trauma injuries heal with hypertrophic scars.
Deciphering between hypertrophic and keloid scars based on how they look under a microscope can be difficult. Therefore, it’s important to share the history of your scar with your dermatologist as completely and accurately as possible.
That’s because keloids and hypertrophic scars differ in areas such as when and where they form. In particular, hypertrophic scars usually occur within 1 to 2 months after the original injury, infection or improper wound closure. Most hypertrophic scars develop in body locations with high skin tension, such as the shoulders, back, central chest/sternum, knees and ankles. Eventually these scars will stop growing.
What are the signs of a hypertrophic scar?
Hypertrophic scars are raised, red and often itchy. They appear 4 to 8 weeks after a skin injury or procedure, and typically grow quickly for up to 8 months. They may flatten over a period that could last a few years. Post surgical hypertrophic scars are linear, following the direction of the incision, while hypertrophic scars resulting from inflammatory and ulcerating lesions can be papular (small inflammatory bumps) or nodular (large raised bump).
Who is most susceptible to hypertrophic scarring?
Hypertrophic scarring affects men and women of all races equally, most often due to deeper injuries in the skin’s dermis.
Before & After Hypertrophic Scars Photos
Unlike hypertrophic scars, keloids are raised or thickened scars that can form at any time after the skin has been injured or operated on. As such, they can appear after ear or body piercings, minor scratches, skin incisions, traumatic wounds and vaccinations. They also can result from inflammation, such as that which occurs with acne, burns or insect bites. Some keloids even appear spontaneously, with no apparent cause. New research suggests that keloids are a disease and six genes have been consistently identified in patients who tend to form keloids.
The key characteristic is that keloids extend beyond the site of the original wound. They tend to be irregularly shaped and may become progressively enlarged. This tendency to continue to grow is the main difference between keloid and hypertrophic scars. Furthermore, unlike other forms of scarring, keloids do not resolve or soften over time. They’re also prone to recurring after surgical attempts to remove them. A combination treatment approach to improvement of keloids is needed including injections, laser, surgical procedure and compression.
The causes of keloid scars can be varied. We do not fully understand why some people are more prone to developing keloids, or why a person may develop a keloid scar in one pierced earlobe and not the other.
What are the signs of a keloid scar?
Keloids are firm, raised scars that may appear shiny and dome-shaped, ranging in color from pink to red, purple or brown. They may also have surface ulceration and contain tiny visible blood vessels (known as telangiectasias). Some keloids become quite large and unsightly, causing severe disfigurement and social embarrassment. Keloids commonly feel painful, itchy, tender and/or tight. They appear most frequently at the shoulders, upper arms, back, sides of the chest and the earlobes. They are less common on the face, but can sometimes appear on the jawline.
Who is most susceptible to keloids?
Keloid scars are equally common in women and men, and less common in children and the elderly. These scars tend to occur most commonly in people during puberty and into their 20s and 30s, decreasing in size after menopause. Additionally, the tendency to form keloid scars often runs in families. Although people with darker skin types – predominantly African-Americans, Asians and Hispanics – are more likely to develop keloids, they can occur in all skin types.
Before & After Keloids Photos
Recommended treatments for both types of scars are highly similar, with minor differences noted below.
Silicone gels and dressings: Silicone sheets, gels, patches and creams are commonly applied to scars, with highly variable results. Although relatively inexpensive, widely available and safe, these products are best used in conjunction with other therapies. The board certified dermatologists at MIAMI DERMATOLOGY AND LASER INSTITUTE can recommend the best scar remedies to suit your individual concerns.
Corticosteroids: Injecting steroids directly into the scar can reduce itching and inflammation and sometimes flatten the scar. The most commonly used steroid for this purpose is triamcinolone. However, intralesional steroids may also make the flattened keloid redder by stimulating the formation of more superficial blood vessels. Additionally, overuse of steroid injections may also lead to skin atrophy (thinning) or depressions.
5-Fluorouracil (5-FU): Injections of this chemotherapy agent have been used, with and without steroid injections, to treat keloid scars. In fact, side effects (possible redness and increased pigmentation) occur less frequently when physicians combine 5-FU with corticosteroids and pulsed dye lasers (see below).
Bleomycin: Studies suggest that injecting this antitumor agent improves the appearance of hypertrophic and keloid scars, perhaps by inhibiting collagen production. Potential side effects include skin atrophy and loss of pigmentation.
Surgical and other interventions
Surgery: Z plasty may be effective for hypertrophic scarring. However, performing surgery on a keloid may trigger the formation of a similar or even larger keloid. Applying pressure dressings to a wound site after excising the keloid can help prevent relapses in some cases, as can using postsurgical therapies such as radiation treatment or lasers.
Pressure therapy: Physicians have long used special garments that apply pressure to the wound as a conservative means of preventing and managing hypertrophic scars. Though evidence behind these devices is mixed, they remain part of the standard of care.
Pulsed-dye lasers, operating at 585 to 595 nm, provide an effective option for primary keloids and early hypertrophic scars. Lasers such as the fractional CO2 laser, fractional erbium (Er:YAG) laser, and often other lasers used in combination provide an effective option when treating hypertrophic scars and keloids. Fractional lasers leave sections of healthy tissue between tiny zones of thermal injury to improve healing and aesthetic results. With many laser therapies, several treatment sessions may be needed. Avoid fully ablative laser therapies for scars due to a high risk of recurrence.
Under the direction of Dr. Jill Waibel, the board certified dermatologists at MIAMI DERMATOLOGY AND LASER INSTITUTE can recommend the best laser therapy for treating your scars.
Radiation therapy is usually reserved for hypertrophic and keloid scars that resist other treatments. However, there are risks such as an increase in skin cancer with radiation.