GUIDELINES IN DERMATOLOGY

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KELOID AND HYPERTROPHIC SCARS

Zafer Türkoğlu1
İrem Doğan2

1University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Dermatology and Venereology, İstanbul, Türkiye
2University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Department of Dermatology and Venereology, İstanbul, Türkiye

Türkoğlu Z, Doğan İ. Keloid and Hypertrophic Scars. In: Kutlubay Z, editor. Guidelines in Dermatology. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.267-273.

ABSTRACT

Keloids and hypertrophic scars (HS) are fibroproliferative disorders caused by an uncontrolled wound healing process with excessive deposition of connective tissue and extracellular matrix. Any type of injury, including burns, surgeries, trauma, vaccinations, piercings and infections, can disrupt the physiologic healing process in susceptible individuals, leading to keloids and HSs. Hemostasis, inflammation, proliferation and remodeling are the four stages of the physiological wound healing process. Any disruption in the physiologic wound healing process can lead to scar formation, but most often this occurs during the final stage, remodeling. Excessive extracellular matrix deposition as a result of STAT3 overexpression, hyperactivation of the TGF-b1-SMAD-MAPK pathway, which occurs during the wound healing phase as a result of a dermal injury is thought to be effective in the pathogenesis. It is thought that the inflammatory process may be triggered through many pathologic pathways that have not yet been proven. Generally, keloids are defined as scars due to persistent inflammation, while HSs are defined as scars that gradually lose this dermal inflammation. This diversity in the inflammation process explains the growth patterns of keloids and HS. Hypertrophic scars are pruritic, whereas keloid lesions may have additional pain. Keloid typically tends to extend beyond the wound margin, whereas HS tends to form inside the wound margin. Despite their high prevalence, keloid and HS are still considered challenging dermatologic conditions, as there is no single definitive and effective treatment. However, they have a significant psychological impact on the patient and significantly affect their quality of life. All patients should be examined both physically and psychologically to decide on appropriate treatment modalities. Surgical manipulation is one of the most effective treatment modalities

in the treatment of hypertrophic scarring, whereas surgical manipulations in the treatment of keloids should be avoided as they may aggregate scar formation. Therefore, clinical differentiation is essential. Due to its direct impact on quality of life and cosmetic concerns of the patients, many clinical trials are currently being conducted on more effective treatment modalities. In this chapter, we aim to describe the pathogenesis of HS and keloid, epidemiology, risk factors, clinical features and predisposing factors, histopathology, traditional treatment options and promising new clinical trials.

Keywords: Cicatrix; Cicatrix hypertrophic; Fibrosis; Keloid; Wound healing

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