Scars are produced as a physiological response of our organism to an alteration of any of the tissues that compose it. In the skin, when the margins of the wounds are well faced, healing is usually of good quality, but in some cases hypertrophic scars and keloids appear.
How can we identify hypertrophic scars?
Hypertrophic scars are raised, reddish, hard, inelastic lesions that cause itching or pain. However, they do not invade the surrounding healthy tissues and have a tendency to regress spontaneously, although sometimes very slowly. So-called keloids are, on the other hand, scars that grow beyond the margin of a skin lesion, from an abrasion or a wound. These lesions develop a much wider and more extended scar with respect to the original damage, invading the surrounding healthy tissue and have no tendency to spontaneous involution (unexpected improvement or healing).
At first, the keloid looks like a simple raised scar, since the lesion has a smooth, hairless and translucent surface. In this initial phase, keloids have an intense red color because they are vascularized, i.e. with sufficient blood and lymphatic vessels in the tissue.
Subsequently, the scar begins to extend and protrude, clearly exceeding the limits of the initial lesion. It is at this point that the keloid shows a pink color and its texture becomes increasingly thick and hard. On the surface the keloid has no hair follicles in which to grow hair or sweat glands.
Although these lesions can appear on any area of skin affected by abrasions or wounds, some areas of the body appear to be more sensitive. They tend to be more common on the deltoid region of the body (shoulder), on the sternum and on the upper back. The earlobes and back of the neck are other fairly common targets for keloids.
What are the risk factors?
There are predisposing factors to pathologic scarring, both local (scarring by secondary intention, poor scar orientation, injurious agents causing burns) and systemic (young age, black ethnicity, female sex). Apart from these factors, there are several treatments to combat hypertrophic scars and keloids:
– Pressure therapy: This controlled compression system responsible for moving venous and lymphatic flow can be an effective method to improve cellular fluid clearance and improve oxygen flow to the affected area.
– Massage.
– Cortisone: Cortisone injections to flatten the elevation of the affected area through its property of atrophying the tissues.
– Substances that inhibit local collagen synthesis.
– Cryotherapy: The treatment consists of applying freeze-thaw sessions in order to flatten the affected area.
– Silicone gel: Application of a bandage with silicone gel to hydrate the scar and prevent water loss by vaporization of the lesion.
– Interferon: Another injection that can combat scars are injections of interferon – proteins produced in response to pathogens.
– Surgical therapy (associated or not with brachytherapy/radiotherapy): Surgical intervention removes scars by excision. Keloids have a tendency to recur.
Before deciding on any treatment, see your Plastic, Aesthetic and Reconstructive Surgery specialist to diagnose the lesion and apply a solution according to your medical history.