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# Hypertrophic vs. Keloid Scar
- URL: https://www.theplasticsfella.com/hypertrophic-vs-keloid-scar/
- Published: 2021-03-14T16:20:03.000Z
- Updated: 2022-08-13T09:17:57.000Z
- Description: Abnormal scars can be defined as Hypertrophic or Keloid. They do not follow normal scar evolution and difference from clinical, morphological and treatment perspective.
- Author: PlasticsFella
- Tags: Skin and Soft Tissue

## 

Normal scars follow a cycle of matrix proliferation, stabilisation and maturation. Hypertrophic scars follow a more protracted course, whilst Keloid scars do not follow this cycle of evolution. They are both **abnormal scars*.

The main differences between hypertrophic and keloid scars can be remembered by the mnemonic **BAD SCAR.**

![](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2022/08/Keloid-and-Hypertrophic-Scars.png)

---

## Clinical Differences

There may be symptoms of pain, tenderness, and pruritus.

![Hypertrophic Scar](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/03/hypertrophic-scar2.jpg)

Hypertrophic Scar

![Keloid Scar](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/03/keloid9.jpg)

Keloid Scar

---

## Morphological Differences

The diagnosis of keloids and hypertrophic scars is clinical. If uncertain, consider a biopsy.

|                    | **Hypertrophic**      | **Keloid**                                 |
| ------------------ | --------------------- | ------------------------------------------ |
| **Collagen**       | Type III              | Type I + III                               |
| **Fibers**         | Parallel to epidermis | Random to epidermis                        |
| **Myofibroblasts** | Present               | Absent                                     |
| **Cell Number**    | Increased             | Decreased in nodulesIncreased in periphery |

![Histological and Morphological differences of Keloid, Hypertrophic and Normal scars](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/03/Histology-of-normal-skin-sample-compared-hypertrophic-and-keloid-scars-A-histological-e1561661712684.png)

---

## Natural History

A normal scar increases in height and firmness during **matrix proliferation*, The scar then **stabilises* for 6-9 months before becoming flat and smooth during **maturation*. **Hypertrophic** scarring begins like normal scarring, except with a prolonged time course. **Keloid** scarring does not follow the normal scar evolution pattern.

|                        | **Hypertrophic**   | **Keloid** |
| ---------------------- | ------------------ | ---------- |
| **Resolve**            | Spontaneous (most) | No         |
| **Recur post-Surgery** | No                 | Yes        |

![Scar Healing](https://storage.ghost.io/c/a0/9f/a09fd7b4-d396-4b28-aed3-b87e20483292/content/images/2021/03/Screenshot-2019-06-27-at-20.00.31.png)

The different forms of treatment options and their varying success rates emphasises the difference between keloid and hypertrophic scars. It also suggests a significant heterogeneity within each category of the scar.

---

## Sources

1. **[Hypertrophic response and keloid diathesis: two very different forms of scar](https://www.ncbi.nlm.nih.gov/pubmed/16327593?ref=theplasticsfella.com)*. Plast Reconstr Surg. 2005 Dec;116(7):150e-157e. Burd A, Huang L.
2. **[Duration of Scar Maturation: Retrospective Analyses of 361 Hypertrophic Scars Over 5 Years](https://journals.lww.com/aswcjournal/Abstract/2019/01000/Duration%5Fof%5FScar%5FMaturation%5F%5FRetrospective.5.aspx?ref=theplasticsfella.com)*. Advances in Skin & Wound Care: January 2019\. Kant, Sander, MD