Abstract
Excessive scars form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus and contractures, excessive scarring significantly affects the patient's quality of life, both physically and psychologically. Multiple studies on hypertrophic scar and keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, most likely owing to poor understanding of the complex mechanisms underlying the processes of scarring and wound contraction. In this review we summarize the current understanding of the pathophysiology underlying keloid and hypertrophic scar formation and discuss established treatments and novel therapeutic strategies.
Highlights
A total of 100 million patients develop scars in the developed world alone each year as a result of 55 million elective operations and 25 million operations after trauma [1]
Excessive scarring was first described in the Smith papyrus about 1700 BC [2]
Evidence to date strongly suggests a more prolonged inflammatory period, with immune cell infiltrate present in the scar tissue of keloids, the consequence of which may contribute to increased fibroblast activity with greater and more sustained extracellular matrix (ECM) deposition [31]
Summary
A total of 100 million patients develop scars in the developed world alone each year as a result of 55 million elective operations and 25 million operations after trauma [1]. Excessive scars form as a result of aberrations of physiologic wound healing and may develop following any insult to the deep dermis, including burn injury, lacerations, abrasions, surgery, piercings and vaccinations. Many years later Mancini (in 1962) and Peacock (in 1970) differentiated excessive scarring into hypertrophic and keloid scar formation. Per their definition, both scar types rise above skin level, but while hypertrophic scars do not extend beyond the initial site of injury, keloids typically project beyond the original wound margins [3,4]. Clinical differentiation between hypertrophic scars and keloids can be problematic. There are clinical similarities between hypertrophic scars and keloids, there are some clinical, histological and epidemiological differences (Table 1 and Figure 1) that indicate that these entities may be distinct from one another [5,6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
