Keloids and hypertrophic scars

Published on 11/06/2015 by admin

Filed under Pediatrics

Last modified 22/04/2025

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Keloid nodule on earlobe from ear piercing.

Hypertrophic scars at site of varicella lesion. It subsequently resolved.

CLINICAL FEATURES

Keloids are firm, progressively enlarging nodules with a shiny, hairless surface that begin at sites of skin trauma. They may be painful or itch. They are most often on the earlobes following ear piercing but occasionally appear on the trunk or extremities. Stellate shapes develop as the keloid grows beyond the boundaries of the initial skin injury. They are often hereditary with a dominant pattern of inheritance with up-regulation of TGF beta.

Progressive enlargement over 20 to 40 years is common resulting in lobulated or pedunculated masses.

Simple surgical excision often results in regrowth larger than the original keloid.

Hypertrophic scars are raised hairless, shiny nodules that appear at sites of skin injury. Unlike keloids, they do not spread beyond the original scar site and stop growth after a few months, and then slowly regress.

TREATMENT

Intralesional injections of glucocorticosteroids will soften and flatten the keloid. Surgery followed by intralesional injections of glucocorticosteroids weekly over 1 month may be effective for large keloids, particularly those around the ear.

The corticosteroid injections may result in hypopigmentation in the area.

No treatment for hypertrophic scars is usually necessary as regression is expected.

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