Hyperthrophic or Keloid Scar

If a scar is thickened, does not invade normal tissue, and lies across the relaxed skin tension lines (creases in the skin), then it is a hypertrophic scar. If it is elevated and invading normal tissue, then it is a keloid scar. All types of scarring can occur on all areas of the body, but some areas such as the chest, knees and elbows are more likely to scar.

Both keloids and hypertrophic scar tissues are abnormal responses to trauma. A keloid is an abnormal scar that grows beyond the boundaries of the original site of skin injury.

Keloids have the clinical appearance of a raised amorphous growth and are frequently associated with pruritus and pain. Microscopy observation reveals randomly organized collagen fibers in a dense connective tissue matrix. In normal scars, the collagen bundles are arranged parallel to the skin surface.

An hypertrophic scar is a widened or unsightly scar that does not extend beyond the original boundaries of the wound. Unlike keloids, an hypertrophic scar reaches a certain size and subsequently stabilizes or regresses. Similar to keloids, hypertrophic scars are associated with adverse wound healing factors.

There is nothing specific that can indicate what will be the ultimate appearance of a scar or what type of scar it will be. The way in which a wound heals is different for every individual and is determined by genetics, environment and how you care for it.

Keloid or hypertrophic scar: the controversy: review of the literature.
Atiyeh BS, Costagliola M, Hayek SN.
Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon. aata@terra.net.lb

Keloid and hypertrophic scars are 2 types of excessive scarring observed clinically that require different therapeutic approaches. The clinical course and physical appearance define keloids and hypertrophic scars as separate entities; however, they are often confused because of an apparent lack of morphologic differences. Nevertheless, clinical differences between hypertrophic scars and keloids have long been recognized by plastic surgeons and dermatologists. Yet, translating these differences into morphologic or biochemical distinctions has prompted much conflict in the literature. The present report is an attempt to clarify the longstanding controversy regarding these 2 similar yet separate and nonidentical entities by highlighting the reported points of differentiation as well as the similarities.

Quality of life of patients with keloid and hypertrophic scarring.
Bock O, Schmid-Ott G, Malewski P, Mrowietz U.
Primary Health Care Center, Halsan 2, Fabriksgatan 17, 55 185, Jonkoping , Sweden, oliverbock@hotmail.com.

Keloid and hypertrophic scarring represent chronic disfiguring dermatoses with a high resistance to therapy. The aim of our study was to assess for the first time the quality of life of patients with hypertrophic scars and keloids, because they suffer from quality of life impairment as much as patients with other chronic skin diseases. An item-pool was created modifying and supplementing the items of the Questionnaire on Experience with Skin Complaints. This questionnaire was distributed to 100 outpatients with keloids and hypertrophic scars. A factor analysis was used to identify the underlying dimensions. Two scales (psychological and physical impairment) of the questionnaire with nine and five items, respectively, were established. Test-retest reliability of the questionnaire was excellent (corr>0.9). Good validity was suggested by the correlation of physical impairment with pain (P</=0.001), pruritus (P<0.001), and the amount of restriction of mobility (P<0.001). The psychological scale was associated with pain and restriction of mobility, although the correlations were lower. This study demonstrates for the first time an impairment of quality of life in a large group of patients with keloid and hypertrophic scarring.

Studies of transforming growth factors beta 1-3 and their receptors I and II in fibroblast of keloids and hypertrophic scars.
Bock O, Yu H, Zitron S, Bayat A, Ferguson MW, Mrowietz U.
Primary Health Care Center, Fabriksgatan 17, SE-552 85 Jonkoping, Sweden. oliver.bock@ltjkpg.se

Keloids are benign skin tumours occurring during wound healing in genetically predisposed patients. They are characterized by an abnormal deposition of extracellular matrix components, particularly collagen. There is uncertain evidence that transforming growth factor-beta (TGFss) is involved in keloid formation. Therefore we investigated the expression of TGFss1, 2 and 3 and their receptors in keloids, hypertrophic scars and normal skin. Dermal fibroblasts were obtained from punch biopsies of patients with keloids and hypertrophic scars and from normal skin of healthy individuals. Total RNA was isolated and the expression of TGFss1, 2 and 3 and of TGFss receptors I and II (TGFssRI and II) was analysed by real-time PCR using the Lightcycler technique. Our data demonstrate significantly lower TGFss2 mRNA expression in hypertrophic scar fibroblasts as compared with fibroblasts derived from keloids and normal skin (p<0.05). In contrast, TGFss3 mRNA expression was significantly lower in keloid fibroblasts in comparison with fibroblasts derived from hypertrophic scar and normal skin (p<0.01). TGFssRI mRNA expression was significantly decreased in hypertrophic scar fibroblasts (p<0.01) and TGFssRII mRNA expression was decreased in keloids compared with hypertrophic scar fibroblasts (p<0.001). The ratio of TGFssRI/TGFssRII expression was increased in keloids compared with hypertrophic scar and normal skin fibroblasts. As recently supposed, an increased TGFssRI/TGFssRII ratio could promote fibrosis. Therefore our data support a possible role of TGFssRI and TGFssRII in combination with a certain TGFss expression pattern as fibrosis-inducing factors in keloids.

[Distribution and expression of transforming growth factor beta and their receptors in hypertrophic scar]
[Article in Chinese]
Lu L, Chen YL, Zhang QG.
Department of Burns, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China.

OBJECTIVE: To explore the role of transforming growth factor beta (TGF beta) and their receptors (TGF beta-R) in the pathogenesis of hypertrophic scar. METHODS: Specimens of normal skin and hypertrophic scar were harvested and the distribution and the expression of the TGF beta and TGF beta-R were determined by immunohistochemistry and in situ hybridization method. RESULTS: The expressions of TGF beta and TGF beta-RII in normal skin were higher than the expression of TGF beta 1, TGF beta 2 and TGF-RI. But in hypertrophic scar the results were on the contrary. The mRNA expressions of TGF beta 1, TGF beta 2 and TGFRI were evidently increased with decreased mRNA expression of TGF-beta 3 and TGFR II in the hypertrophic scar when compared with those in the normal skin. CONCLUSION: The expression of TGF-beta (beta 1, beta 2, beta 3) and their receptors in different levels during the process of wound healing might be related to the formation of hypertrophic scars.

Skin Remodeling is the Key to Scar Reduction
The removal or reduction of scars and marks from lesions to the skin depends on a process called "skin remodeling". The skin is designed to heal wounds quickly to prevent blood loss and infection. Scars are manufactured from a rapidly formed "collagen glue" that the body deposits into an injured area for protection and strength. In ideal skin healing, wounded skin is rapidly closed, then the healed area is slowly reconstructed to remove the residual collagen scars and blend the skin area into nearby skin. Scar collagen is removed and replaced with a mixture of skin cells and invisible collagen fibers. This skin remodeling may continue in a skin area for ten years. In children the remodeling rate is high and scars are usually rapidly removed from injured skin areas. But as we reach adulthood, this rate diminishes and small scars may remain for years. One way to accelerate remodeling is to induce a small amount of controlled skin damage with a needle, laser, or other means, and then let the body repair processes rebuild the skin area. A second method is to use skin healing accelerators to increase the body's natural healing processes to obtain an even better final results.

Skin Remodeling & Scar Reduction with BIOSKINREPAIR

A balance between collagen formation and degradation is essential for normal wound healing. Inadequate wound healing results in wound breakdown, and exaggeration results in hypertrophic scars and keloids.

BIOSKINREPAIR contains glycoprotein enzymes and peptides that REGULATE and help the process of skin remodeling. The enzymes in BIOSKINREPAIR loosen the scar proteins and help in the removal of the scar proteins.

BIOSKINREPAIR also help the process of rebuilding new collagen and elastin into the skin by activating skin's metalloproteinases that remove damaged proteins (sun as sun-damaged collagen and elastin) and scars. At the same time they help activate the mechanism that protects your body against excessive breakdown of protein.

BIOSKINREPAIR helps the skin to (1) regenerate new collagen and elastin which improve skin firmness and elasticity, (2) increase the production of water holding glycosaminoglycans which is true moisturizing, (3) improve the skin's blood vessel microcirculation, (4) produce biochemical energy from nutrients in the body blood supply, (5) increase the natural defense mechanism against oxidative damage, and (6) repair damage to the protective skin barrier.

As the skin is rebuilt and scars removed, the elastic properties of the skin pull it into a smooth surface.

During skin remodeling, the old damaged protein is removed and replaced with new collagen and elastin fibers. This removes scar tissue, shrinks keloid scars and hypertrohic scars, relieves itching, restores skin elasticity, and reduces wrinkles.

Last modified: June 20, 2009

Get rid of keloid and hypertrophic scars, relieve itching and eliminate all types of skin blemishes, while moisturizing, protecting, repairing and renewing your skin with BIOSKINREPAIR

Regulates dermal fibroblast proliferation and excess collagen, and thus helps to prevent and reduce keloid scars and hyperthropic scarring. Acts as a potent antioxidant and anti-inflammatory. Regulates blood vessel formation and oxygenation within the skin so that fewer nutrients get into the scar tissues. Halts keloid scar itching. Smoothes old surgery scars and also rough and dry skin.

scar removal for keloid and hypertrophic scars

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