Keloid scars

Healing ability after surgery is a somehow unpredictable biological phenomenon with extreme variability between ethnicities, individuals, skin quality of different anatomical areas, features of the surgical technique and multiple genetical and mechanical factors; there are well known factors leading to a unfavorable aesthetic outcomes, including but not limited to black skin, sebaceous or oily skin, certain areas like back, shoulders, chest, mandibular angle and earlobe, abdomen, etc, causes by mechanical stress and pull from the wound edges like hematoma, seroma, excessive postoperative swelling or inflammation, poor surgical planning, features inherent to the surgical technique, etc; notwithstanding some areas are prone to superb aesthetic quality of the scars, like the scalp, face, eyelids, ears, lips, nose, intraoral mucosa, areolas, etc.

A hypertrophic scar occurs when there is a collagen overgrowth beyond the requirements of wound closure and healing, exceeding the real needs of the curative process and, therefore, leading to a raised relief along the scar due to excessive activity of the fibroblasts or highly specialized scar cells. Some associated symptoms can be redness, itch, hypersensitivity, pain, puckering, contraction, retraction, irregularities, etc.

Treatment is initially interventionist, since most cases evolve unfavorably and progressively; a combination of pressure therapy and flattening plasters of silicone or polyurethane plus corticoid injections might be the first option; late and scheduled surgical revision associated to perioperative radiotherapy is the only remedial option in most keloids.