Hypertrophic Scars and Keloids      

start with the short video here or here   (for radiation here, here and here, general information here, here, here, here and here, for more pictures of keloids go here.)



Injury or surgery in a predisposed individual can result in an abnormally large scar. A hypertrophic scar is inappropriately large but remains confined to the wound site and in time regresses; a keloid extends beyond the margins of injury and usually is constant and stable without any tendency to subside. There are histologic differences between hypertrophic scars and keloids. Keloids are often symptomatic, and complaints arise because of tenderness, pain, and hyperesthesia, particularly in the early stages of development. Keloids are most common on the shoulders and chest, but they may occur on any skin surface. Blacks are more susceptible and sometimes are victims of facial keloids. Some patients with cystic acne of the back and chest form numerous keloidal scars.

Treatment.

There is no routinely effective therapy for all keloids, but a variety of treatment methods exists, including intralesional steroid injection, surgical correction, cryotherapy, compression therapy, and irradiation.

Surgical excision followed by radiation: . Different protocols are reported. Radiation is usually given within 24 hours after surgery to subdue the second-generation fibroblasts. The response rate varies between 92% and 73%. Irradiation at a later time is not as helpful.