Scars are a huge issue. When we do surgery and cut through the skin, there is no way to avoid a scar. A lot of promising research is going on with growth factors and other things to try to revolutionize how we approach scars, but nothing is close to coming to the market.
So. What do we know? First lets get the terms clear, as I hear many people tell me they “keloid” when in fact it is a normal or hypertrophic scar.
KELOID: a scar which goes BEYOND the original insult. It is a pathologic scar.
- elevated
- frequently red
- frequently itchy
- classic example: an ear piercing. Oddly it doesn’t tend to happen as often when the ears are pierced young, so I see this more when they get a second piercing in their teens.
Areas which tend to keloid more:
- MIDLINE of body. anterior chest wall (the heart surgery incision), suprapubic (C section). When I did the old style of breast reduction with the anchor scar, if someone formed a keloid (uncommon) it tended to do so only on the part of the scar near the sternum- near the midline.
- upper arm
Why?
- Genetics
- Tension
- Inflammation
HYPERTROPHIC SCARS are not keloids. They can be raised, red, and not pretty. Same issues lead to them as to keloids, and the treatments are very similar.
NORMAL SCAR. If your scar is flat, white, non itchy, it is a normal scar. They can commonly widen, particularly when over a joint like the knee, shoulder, or elbow.
