Pathology / Epidemiology

1. Types of wound prone to hypertrophic / keloid scar formation
   • Infection
   • Trauma
   • Burns
   • Tension (especially over the sternum)
   • Wounds in certain areas of the body
2. Differences in clinical course
   • Hypertrophic scars tend to appear soon after injury, usually regress spontaneously
   • Keloid scars appeara months after injury and continue to grow
3. Treamtent options
   • Non-surgical: mechanical pressure therapy (day and night up to a year) with topical silicone gel sheets
   • Surgical: revision of scar with closure by direct suturing, local Z-plasty or skin grafting to avoid excess skin tension
   • Intralesional steroid / LA injection - tiamcinolone in combination with lignocaine

Approach

• Scar can be on any part of the body where there has been an incision in the skin
• Describe the scar - point out that the scar area is more prominent than the surrounding skin and add details

Features	Hypertrophic scar	Keloid scars
Appearance	Confined to wound margins	Scar extends beyond wound margins
Site	Across flexor surfaces and skin creases	Earlobes, chin,neck, shoulder, chet
Age	Any age (commonly 8-20 years)	Puberty to 30 years
Gender	M = F	F > M
Race	All races	Black and Hispanic races
Pathology	Normal rate of collagen synthesis but increased breakdown of collagen by collagenase activity	Increased rate of collagen synthesis (increased proline hydroxylase activity) and Increased breakdown of collagen (increased collagenase activity)

 
Completion

1. As how the scar affects lives