Scars arise as a result of abnormal wound healing and can appear clinically in different forms. Thick and raised scars are cosmetically unsightly and in some occasions can be associated with symptoms such as itching or pain.
Keloids and hypertrophic scars both appear clinically as raised thick scars but present 2 different forms of scars. Keloids are raised, firm scars that typically extend beyond the site of injury or surgical margin and can continue to grow with an unpredictable course. Whilst most keloid scars appear as a result of trauma or surgery, in some cases there can be a genetic predisposition to keloids. Spontaneous keloids can occur in some individuals although this is less common.
Hypertrophic scars tend to develop after trauma or surgery and represent an exaggerated or abnormal wound healing with thickening of the scar but unlike keloid scars these scars tend to be confined to the site of surgical trauma. Hypertrophic scars are almost always the result of surgery and trauma and unlike keloid scars are less associated with a genetic predisposition. Hypertrophic scars can be symptomatic with itching or pain and they tend to be red in colour which represents the vascular and inflammatory component of the scar.
There are a number of treatments available for both keloids and hypertrophic scars from topical treatments to intralesional steroid injections and laser treatment. Intralesional steroid injections remain the simplest and commonest treatment available often with good results. The treatment may need to be repeated and can be combined with other treatment methods. A topical steroid tape exists and can be used although its efficacy is not as similar as intralesional steroid injections. Topical silicone gel or sheets can also be used although they often help in the preventative phase either soon after surgery or post treatment to maintain the results. They can also help reduce some of the symptoms of pain.
Laser treatments are very effective and can either be used to improve on the colour of the scars such as redness or hyperpigmentation or can help when ablative lasers (fractional included) can modulate the scar. A novel method of treating keloids and hypertrophic scars is through the combination of lasers and steroid solution in a method called laser-assisted drug delivery.
Professor Firas Al-Niaimi is an internationally recognised expert in the field of scars and has published numerous scientific articles in the field of lasers and scars.