Hypertrophic Scars and Keloids: What's the Difference?

Scars tell stories, but some of them can be more challenging to live with. Does your scar feel raised, itchy, or even painful? You’re not alone. Many people struggle with understanding their scars—especially when distinguishing between hypertrophic scars and keloids. 

The good news? There are solutions that can restore confidence and comfort. At Lumine Dermatology, we specialise in treating all types of scars, offering evidence-based therapies tailored to your needs.

What Is a Hypertrophic Scar?

Characteristics of Hypertrophic Scars

Hypertrophic scars are thickened, raised scars that develop at the site of a healed wound. They typically stay confined to the original wound area and can vary in colour from pink to red or even darker shades, depending on your skin tone. These scars form as the body’s natural response to injury, creating excess collagen during the healing process.

Their appearance may soften over time, but without intervention, they often remain noticeable. While hypertrophic scars are not harmful, they can cause discomfort or emotional distress for those who have them.

Common Causes of Hypertrophic Scars

Hypertrophic scarring can result from various situations, including:

• Skin injuries: Everyday cuts, scrapes, or deeper wounds can trigger hypertrophic scar formation when healing conditions are suboptimal.
• Surgical wounds: Tension along a wound site after surgery can lead to thicker scar formation.
• Burn injuries: Thermal damage can result in significant scarring as the skin heals unevenly.

These scars are more likely to develop when a wound undergoes prolonged inflammation, infection, or excessive tension.

Areas of the Body Prone to Hypertrophic Scarring

Certain areas of the body are at a higher risk for developing hypertrophic scars due to their anatomy and exposure to movement or pressure. These include:

• Shoulders: Often prone due to frequent movement and stretching.
• Chest: Skin tension and frequent exposure can contribute to scarring.
• Jawline and neck: Areas of increased skin tension are more prone to scarring, this is a common area for hypertrophic acne scars
• Joints: Areas like knees and elbows are more likely to scar due to the constant flexing and stress placed on the skin.

What Is a Keloid Scar?

Defining Keloid Scars

A keloid scar is a type of abnormal scar that grows excessively, spreading beyond the boundaries of the original injury. Unlike hypertrophic scars, keloids continue to grow and can become quite large and noticeable, sometimes resembling small tumours. These scars often appear shiny, with a rubbery or firm texture, and may cause itching or pain.

How Keloids Form

Keloids form when the body’s wound-healing process goes into overdrive. Immune cells and growth factors stimulate an excessive production of collagen, leading to scar tissue that overextends the original wound area. This abnormal healing response can persist for months or even years.

Differences Between Keloid Scars and Normal Scars

Keloid scars differ from normal scars in several key ways:

• Appearance: Keloids are usually larger, darker, and more raised than normal scars.
• Growth pattern: They grow uncontrollably and extend into the surrounding skin.
• Persistence: Unlike normal scars that fade over time, keloids tend to persist and may worsen without treatment.

Hypertrophic Scar vs. Keloid: Key Differences

Visual Differences

Hypertrophic scars and keloids are often confused due to their raised appearance, but there are notable visual differences:

• Hypertrophic scars remain within the boundaries of the wound and tend to lighten over time.
• Keloid scars spread beyond the wound edges, often becoming shiny, rubbery, and denser in texture.

Formation and Growth Patterns

The two types of scars differ in their formation and growth:

• Hypertrophic scars form as part of the body’s natural healing process but stabilise after a few months.Hypertrophic scars usually form right after the wound has healed.
• Keloids grow aggressively, even after the wound has healed, and can continue to expand indefinitely. Keloids often develop a few months after the wound has seemingly healed.

Risk Factors and Triggers

Several factors increase the likelihood of developing these scars:

• Hypertrophic scars: Result from excessive tension on the wound or prolonged inflammation.
• Keloids: Are more common in individuals with darker skin tones, genetic predisposition, and certain types of skin injuries.

Symptoms and Appearance

How to Recognise a Hypertrophic Scar

Hypertrophic scars are typically confined to the original wound site and may appear:

• Reddish or pink: Their colour can fade with time but remains noticeable.
• Thick and raised: The texture may feel firm to the touch.
• Itchy or tender: These symptoms are more common in the early stages of healing.

Identifying a Keloid Scar

Keloid scars often display distinct characteristics, such as:

• Raised, lumpy texture: Extends into surrounding healthy skin.
• Shiny surface: The scar may have a polished, rubbery appearance.
• Discomfort: Can cause itching, tenderness, or even pain in severe cases.

Causes and Risk Factors

Why Do Hypertrophic Scars Occur?

Hypertrophic scars occur due to an overproduction of collagen in the skin during the healing process. Infection, excessive skin tension, or poor wound care can exacerbate their formation. Surgical wounds or burns are particularly prone to hypertrophic scarring because of the depth and severity of tissue damage.

Factors Leading to Keloid Formation

Keloid scars are caused by an overactive healing response. Triggers include minor injuries, such as:

• Acne scars: These can develop into keloids in predisposed individuals.
• Piercings and tattoos: Skin punctures often lead to abnormal scarring.
• Surgical excisions: Deep wounds have a higher risk of forming keloids. Surgical technique may also play a role in the development of keloids.

Genetic and Environmental Influences

Genetic predisposition plays a significant role in keloid formation. Individuals with a family history of keloids or those with darker skin tones are more susceptible. Environmental factors like prolonged wound healing or repetitive trauma to the area can also contribute.

Treatment Options

For Hypertrophic Scars

1. Topical Treatments

Topical treatments like silicone sheets and gels are commonly used to reduce the thickness and visibility of hypertrophic scars. These products help retain moisture in the scarred area, promoting healing.

2. Corticosteroid Injections

Intralesional corticosteroids are often recommended to flatten hypertrophic scars and alleviate symptoms like itching and redness. This method works by reducing inflammation and collagen production in the scar tissue.

3. Silicone Sheets and Gel Therapy

Silicone therapy remains a gold standard for managing hypertrophic scars. Regular application can significantly improve scar texture and colour over time.

4. Surgical Intervention

For severe cases, surgical removal of hypertrophic scars may be necessary. This is often followed by additional therapies to prevent recurrence, such as pressure garments or steroid injections.

For Keloid Scars

1. Cryotherapy

Cryotherapy uses liquid nitrogen to freeze and shrink keloids. This method is particularly effective for smaller scars and can be combined with other treatments.

2. Laser Treatments

Laser therapy, especially pulsed-dye lasers, can reduce the size and discolouration of keloid scars. It works by targeting blood vessels within the scar tissue. Fractional carbon dioxide lasers can also be used to deliver steroids into the scar (minimizing the need for injections) and to optimize skin texture. Picosecond lasers e.g Picosure Pro can also help remodel scar tissue and treat hyperpigmentation. 

3. Radiation Therapy

Radiation therapy is sometimes used after surgical removal of keloids to reduce the risk of recurrence. While effective, it is usually reserved for severe cases due to potential side effects.

4. Emerging Treatments

Innovative approaches, such as combining corticosteroids with other therapies, microdoses of botulinum toxin, are showing promise. Research into growth factor inhibitors and immune-modulating drugs may revolutionise keloid management in the future.

Is It Possible to Fully Prevent Both Types of Scars?

Preventing scars entirely is challenging, but taking proactive steps can reduce your risk. Proper wound care is essential:

1. Clean and cover wounds: Prevent infection and promote faster healing.
2. Use silicone sheets: Apply early to minimise scarring.
3. Avoid tension on the wound: Keep the area relaxed and immobilised. Post surgery, minimizing tension over the wound from exercise also helps improve post surgical wound outcomes.

Those prone to keloids should avoid unnecessary skin injuries, such as piercings or tattoos, in high-risk areas.

When to See a Specialist

Not all scars require medical intervention, but you should consider seeing a specialist if:

• The scar causes significant pain or discomfort.
• It grows rapidly or becomes discoloured.
• It limits mobility or affects your quality of life.

At Lumine Dermatology, we offer personalised treatment plans for both hypertrophic scars and keloids. Our team of experts uses advanced techniques to help you achieve the best possible outcome.ids. Our team of experts uses advanced techniques to help you achieve the best possible outcome.

Take the First Step Toward Healthier Skin

At Lumine Dermatology, we understand the physical and emotional impact of scars. Whether it’s a hypertrophic scar or a keloid scar, our team uses evidence-based therapies and advanced techniques to minimise scarring and improve skin texture. From corticosteroid treatments to innovative laser therapies, we tailor solutions to meet your needs.

The result? Smoother skin, renewed confidence, and expert care every step of the way. Schedule a consultation today, and let us help you rediscover your skin’s natural beauty.