The Difference between Keloid & Hypertrophic scars

ABC7’s The More in the Morning team spoke with Dr. Michael K. Kim, Board-Certified Plastic Surgeon, to discuss the differences between keloid scars and hypertrophic scars and the different ways to treat them. Hypertrophic scars and keloid scars are two of the most known types of scars. On the surface, hypertrophic scars and keloid scars can appear very similar, leading to confusion among patients.

Hypertrophic Scars

Firstly, let’s define what hypertrophic scars are. Hypertrophic scars are caused by a protein called collagen, which repairs and strengthens the broken tissue in a wound. The final step of the wound healing process stops collagen production, and the body naturally breaks down any excess. However, sometimes excess, or continual production of collagen causes the skin to rise, creating a visible scar.

Therefore, hypertrophic scars are more likely to form on or around areas with movement, such as joints and on the face. Although they can appear red or pink initially, hypertrophic scars do tend to fade over time.

Keloid Scars

Keloid scars are also caused by excess or continual production of collagen. However, the fibers themselves are structured differently. Hypertrophic scar fibers are often rigid and organized. Keloid fibers, on the other hand, are thicker and more disorderly. Like hypertrophic scars, keloids are more likely to form on or around areas with movement, such as joints and on the face. Keloids are also more common in people with darker pigmentation of the skin.

How To Tell The Difference Between Keloid And Hypertrophic Scars?

keloid vs hypertrophic scars
  • HEIGHT - Hypertrophic scars are visible and oftentimes raised above the skin, although they rarely exceed 4mm in height. On the rare occasion, a hypertrophic scar may not be raised, but a differentiating factor of keloid scars is that they are always raised above the skin - typically by more than 4mm.
  • APPEARANCE - Although both hypertrophic and keloid scars can be raised above the skin, they do vary slightly when it comes to appearance. Hypertrophic scars are either red or pink and are usually hard and sturdy. Keloid scars, on the other hand, can come in a variety of colors ranging from pink to purple and oftentimes appear to have a shiny surface.
  • SHAPE/LOCATION - One of the easiest ways to tell hypertrophic and keloid scars apart is to take a closer look at the shape of your scar and its location. The most definitive feature of a keloid scar is that they expand beyond the boundaries of the original wound, spreading to the surrounding tissue. It's not uncommon to find keloid scars in areas adjacent to the original wound, whereas hypertrophic scars will always stay within the boundaries of the original wound that caused them.

How To Treat Keloid Scars & Hypertrophic Scars?

The good news is that the treatment methods for hypertrophic scars and keloid scars are in many cases similar! Although hypertrophic scars are generally easier to treat because they regress over time, the appearance of both hypertrophic scars and keloid scars can be dramatically improved through the use of Silicone-based products. Silicone is infamous in scar treatment for its ability to halt water loss and reduce collagen production, something that stops the growth process in keloid scars and helps results in a softer, flatter scar over time. There are a ton of silicone-based scar gels and sheeting options available to help patients treat keloid and hypertrophic scars, it's just a matter of finding a brand you love and sticking with them!

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