Wound Care: Abnormal Scarring

Definitions

• Hypertrophic Scar: Tissue Stays Within the Margin of the Original Scar
  • Usually Regresses Over a Period of Time
  • Composed of Organized Type III Collagen
  • No Genetic Predisposition
• Keloid: Tissue Extends Beyond the Margin of the Original Scar
  • Usually Does Not Regress with Time
  • Composed of Disorganized Type I & III Collagen
  • Autosomal Dominant Genetic Component

Considerations

• Exhibit Excess Collagen Formation with Varied Numbers of Fibroblasts
• Both Types are More Common in Black/Asian Ethnicities

Diagnosis

• Clinical Diagnosis Based on History & Physical Exam
• Consider Biopsy of Uncertain to Rule Out Other More Dangerous Conditions

Treatment

• Initial Treatment: Intralesional Steroid Injection
  • May Consider Silicone Gel & Pressure Therapy for Hypertrophic Scars First
  • Triamcinolone Acetonide 10-40 mg/mL
• If Fails: Surgical Excision
  • High Recurrence Rate but Hypertrophic Scar Responds Better
  • Lowest Recurrence: “Triple Keloid Therapy”
    • Z-Plasty, Then Steroid Injection & Silicone Sheet Application