Hypertrophic scars and keloid

In a typical wound, anabolic and catabolic processes achieve equilibrium approximately 6-8 weeks after the original injury. At this stage, the strength of the wound is approximately 30-40% of that of healthy skin. As the scar matures, the tensile strength of the scar improves as a result of the progressive cross-linking of collagen fibers. At this point, the scar is usually hyperemic and it may be thickened, but it tends to subside gradually over months until a flat, white, pliable, possibly stretched, the mature scar has developed.

When an imbalance occurs between the anabolic and catabolic phases of the healing process, more collagen is produced than is degraded, and the scar grows in all directions. The scar is elevated above the skin and remains hyperemic. Excessive fibrous tissue is classified as either a keloid or a hypertrophic scar.

Both hypertrophic scars and keloids are characterized by erythematous, pruritic, raised fibrous lesions caused by thermal injuries and other injuries that involve the deep dermis.  Hypertrophic scars and Keloid scars do not grow beyond the boundaries of the original skin injury and they are not harmful but can be itchy and even painful to touch.

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