Your Beautiful Magazine!
Page 20
Female Focus
Information supplied by
Dr. I. Poole, Clinica El Arenal. found at Av. Arenal 2, Jávea. Tel: 965 792 418 11am - 1pm
clinicaarenal@gmail.com
Keloid and Hypertrophic scars
This month I would like to talk about certain uncommon scars that may develop in some people.
Keloid and hypertrophic scars are a type of benign growths of the dermal layer of the skin caused by an overgrowth of non encapsulated connective tissue rich in collagen fibres.
These develop during the healing process of burns and wounds and are quite similar to dermal tumours or fibroids. The healing process is divided in 3 stages, -The first one called Productive phase takes 3-5 days and it is characterised by an inflammatory reaction with an increase of cells and capillar vessels that results in the healing of the wound and the closing of the edges. -The second is called Collagen phase and usually takes until the 17th day with an increase of fibroblasts that produce collagen fibres. -The third is Maturation phase and lasts until the 42nd day (six weeks) and it is characterised by a remodelling of such collagen fibres, a decrease of the number of cells, retraction of the scar and progressive softening. After this phase, all scars continue to heal for months or years eventually leaving thin lines.
Hypertrophic scars start to form when the end of the 6th week phase does not begin. Until then, the evolution will always be different according to patient’s genetics, age, site and nature of the wound or the way that it was initially treated.
Keloids are related to traumatic factors, local factors and general factors. -Traumatic factors that affect the skin and dermis can be: normal or surgical wounds, burns, skin infections, sites of vaccination or even certain insect bites. -Local factors are related to skin type and thickness, tension on the edges, mobility of the area or the presence of infection or foreign bodies. -General factors can be related to some genetic hereditary tendency as they run in families, race, skin colour, age and hormonal or autoimmune factors.
According to these, keloids are more prevalent within the black race at a
proportion of 6-9 to 1 over the white. They are also more likely to happen on dark coloured Caucasians, Chinese race or red haired people.
They are most prevalent on the first and second decades, rare afterwards and very exceptional on mature people. They may develop all over the body skin but appear most likely on the presternal region of the chest, upper back and top of shoulders, less on ears, beard area, scalp and forehead and a lot less on the lower back, abdomen and legs. The main differential diagnosis between keloid and hypertrophic scars is that the hypertrophic scars will stop growing before the third month and will later soften whereas the keloid will continue growing after the sixth month invading locally both the surface and the underlying dermis.
Treatment For treatment, the use of steroids alone or in combination with surgery have proven good results, and improvement in at least 90% of cases. Steroids can be used as local creams on a 3 times a day basis for a minimum of 3 months or by local injections in combination with anaesthetics once every 3-4 weeks during a period of 3 to 6 months. In some cases it can be advised to remove previous scar tissue but as these scars often come back, this can only be done when steroids are used in combination with surgery during the early stages of the healing process.
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