Dr. Ertan Beyatlı

How to remove a bad scar (keloid)?

(Update: ) - Skin and soft tissue diseases

Keloids are often the result of an overgrowth of dense fibrous tissue that develops after skin injury has healed. Its tissue exceeds the boundaries of the original wound, usually does not stretch spontaneously and tends to recur after excision.

The first description of the keloid (recorded on papyrus) dates back to BC. It concerns the surgical techniques used in Egypt in 1700. Then, in 1806, Alibert wrote in Greek to describe the lateral development of tissue to unaffected skin. from his chele or used the term derived from crab claw.

What is a Hypertrophic Scar?

Unlike the keloid, hypertrophic Scars are typically characterized by erythematous, pruritic, raised fibrous lesions that do not exceed the limits of the initial injury and may undergo partial spontaneous resolution. Hypertrophic scarring is common after thermal injuries and other injuries where there is a deep layer of skin (dermis).

keloid and hypertrophic scar difference

Keloids rarely resolve spontaneously; However, they can become soft and less painful and pruritic with treatment. Following excision therapy alone, keloids recur (> 50%).

Most keloids and hypertrophic scars are primarily cosmetic. However, some keloids or hypertrophic scars can cause contractures, leading to a significant deformity.

Keloids and hypertrophic scars are genetically related to HLA-B14, HLA-B21, HLA-Bw16, HLA-Bw35, HLA-DR5, HLA-DQw3, and blood type A.

Keloids and hypertrophic scars usually don't cause symptoms, but they can sometimes be painful or itchy or cause a burning sensation. In addition to symptomatic relief, cosmetic concern is the primary reason patients seek medical attention.

Source of Keloid Lesions


Keloids trauma tissue exaggerated growth As such, it usually occurs in pre-traumatic areas. Keloids go beyond areas of trauma that lie above the level of the surrounding skin, but they rarely extend into the subcutaneous tissue.

While hypertrophic scars remain limited to the traumatic area, they may regress spontaneously within 12-24 months.

Clinical Findings

Keloids are soft and elastic. Early lesions are usually erythematous. The lesions turn brownish red and pale as they age. Lesions often lack hair follicle and other functioning adnexal glands.

When lesions occur, the clinical course changes. Most lesions continue to grow for weeks to months and others for years. Growth is usually slow, but keloids sometimes grow rapidly and triple over months. When they stop growing, keloids usually don't cause symptoms and remain stable or pull slightly.

Keloids on the ear, neck and abdomen tend to be pedunculated. Keloids in the central chest and extremities are usually raised on a flat surface, and the base is usually wider than the top.

Most keloids are round, oval or rectangular with regular margins; However, some have nail-like structures with irregular borders. Keloids formed in the joint can restrict movement.

Most patients have 1 or 2 keloids; However, few patients have multiple lesions, particularly those with spontaneous keloid, and there are also patients who develop keloids due to acne or chickenpox.

Keloids from hypertrophic scar, not found in hypertrophic scar claw-like They can be distinguished from (clawlike) projections.

Frequency of lesion areas

In light-colored people, keloids tend to be in the descending order of the face (cheek and earlobes), upper extremity, chest, anterior region, neck, back, lower extremity, chest and abdomen.

In dark people, the decreasing order of frequency tends to be the earlobes, face, neck, lower extremities, breasts, chest, back and abdomen.

The decreasing order of frequency in people of Asian descent is the earlobes, upper extremities, neck, breasts and chest.

Causes of Keloid and Hypertrophic Wounds

Actually the reason is unknown. The prevalence of keloids that increase in parallel with increased cutaneous pigmentation suggests a genetic basis, or at least a genetic link.

The primary cause identified for the development of keloids is both trauma to the skin and pathological (eg ear congestion, surgery) and pathological (eg acne, chicken pox). In the presence of foreign matter, infection, hematoma or increased skin tension, it may cause keloid or hypertrophic scar formation in susceptible individuals. Transformant growth factor-beta and adiponectin play a role in the pathogenesis.

Medical care for a keloid

There is no such thing as the best treatment for all keloids. The location, size and depth of the lesion; age of the patient; and the past response to treatment determines the type of therapy used.

Prevention is important, but therapeutic treatment of hypertrophic scars and keloids, occlusive dressings, compression therapy, intralesional corticosteroid injections, cryosurgery, excision, radiation therapy, laser therapy, IFN therapy, 5-fluorouracil (5-FU), doxorubicin, tamoxifen, tacrolimus toxin, hydrogel scaffold and over-the-counter treatments (eg onion extract, hydrocortisone, silicone and vitamin E combination).

Other promising treatments include antiangiogenic factors including vascular endothelial growth factor (VEGF) inhibitors (eg bevacizumab), phototherapy (photodynamic therapy [PDT], UVA-1 therapy, narrow band UVB therapy), transforming growth factor (TGF) -beta inhibitors. are tumor necrosis factor (TNF) -alpha inhibitors (etanercept), recombinant human epidermal growth factor (rhEGF) and recombinant human interleukin (rhIL) -10 for reducing collagen synthesis.

Can Keloid Be Prevented?

The first rule in keloid therapy is prevention. It is an important issue that patients who are known to form keloids should avoid unnecessary cosmetic surgery. Surgical interventions to be performed on these people should have minimal trauma to the tissues and wound care and follow-up should be done after the surgery.

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