Hypertrophic scars and

keloids
Dr. Budiman, SpBP
SMF Bedah Plastik & Rekonstruksi
Dep. Bedah RSPAD Gatot Soebroto

Hypertrophyc scars and keloid

definition

When a scar, instead of becoming soft

and pale in the usual manner,
becomes RED and THICKENED.

Hypertrophic scar

Raised above the level of the

surrounding skin
Rather red initially
Not encroach on the surrounding
normal skin
Eventual tendency to regress
spontaneously

Keloid

Much more florid lesion

Grossly elevated
Tending to spread and involved the
surrounding normal skin
Itching is common
Sometimes with hyperaesthesia and
tenderness to touch

Hypertrophic scars and keloids

differentiation

Artificial division
Single entity of varying severity
Extreme condition: easily recognised
Realty: gradation from the very mildly
hypertrophic scar to the severe keloid
The point at which a HS becomes a
keloid is a matter of opinion
Treatment of both is similar

Hypertrophic scars and keloids

differentiation

The point at which a HS becomes a

keloid is a matter of opinion
Treatment of both is similar

Clinical picture

Black > asian > white

Certain areas have a particular
tendency
- presternal
- deltoid
- earlobe
Scar in the skin line show less
tendency to keloid

Management

Excision
- ?: probability will develop into fresh
keloid
- !: Post-excision treatment
- correction of the contractural
element

Management (cont.)

Steroid injection
- into the substance of the keloid
- flat : stop!
Silicon gel & sheat
Excision + radiation
Garment : pressure