At one of London’s best cosmetic skin clinics, The Cadogan Clinic, they offer a full consultation on your keloid or hypertrophic scar, from diagnosis to administering the possible treatments available to help manage your scar, and will give honest and informed medical consultations from qualified specialists about the best options for you. I spoke to leading plastic surgeon and laser specialist Dr. Ernest Azzopardi and Senior Aesthetician Safae Yemlahi to answer all your key questions on how keloid scars form, when to treat hypertrophics and what kind of solutions are available.
Keloid scars and hypertrophics are enlarged, raised and/or discoloured scars that form after some kind of trauma to your skin, be it minor or major. From raised acne scars to a reaction to a new piercing, burns to surgical sites, there are a whole host of ways that these scars can form. Sometimes itchy, prone to growth, and sometimes spontaneously self-correcting, there’s a lot we don’t yet know about why keloid scars form and how to treat them, but they can create a day-to-day challenge as you adapt to how they change your appearance and/or feel, often itchy or painful.
If you think a scar you have could be hypertrophic or keloid, it’s important to get it checked out by a professional so that they can diagnose the best form of treatment for your sensitive skin. Be it silicone strips, botox, scar removal creams or laser scar treatments, there are likely to be options available.
What is the difference between a keloid scar and a hypertrophic, and what causes them?
Skin scars are on a wide spectrum. From tiny, neat, almost-imperceptible to hypertrophic and onto major keloids. Dr. Azzopardi clarified the differences: “The main difference between a hypertrophic and keloid scar is that hypertrophic scars will stay within the boundary of the original lesion and may spontaneously mature and regress with time. Keloids are excessive scars that continue to grow beyond the boundary of the original scar, and usually do not settle down on their own, and comprise some of the most difficult scars to manage. Linear types may follow surgery or trauma, whilst widespread “sheets” of hypertrophic scars may follow more extensive soft tissue injuries, trauma and or infection.” Both hypertrophic and keloid scars can also occur from relatively trivial injuries or low key issues such as acne.
Though they’re both the the subject of intensive medical research, hypertrophic and keloid scars still pose a lot of questions that the experts currently have no answer to. Doctors have confirmed that there is an element of genetic predisposition, which often needs an environmental trigger (such as an injury). Dr. Azzopardi says “The relative contribution of each factor may be different in each individual, and also different between different sites in the same individual. We know for example, that they happen more commonly in darker-skin types, around the anterior chest, shoulders, earlobes, upper arms, and cheeks, but this list is by no means exhaustive.”
Essentially, they can be a bit of an unpredictable mystery, which makes management all the more challenging.
What do keloid and hypertrophic scars look like?
How long does it take for a hypertrophic or keloid scar to form, and does growth continue long after trauma?
Hypertrophic scars can form as early as 6 weeks into the scarring process and can continue to grow rapidly for up to six months if they’re left alone and not subjected to any preventative treatments. Unpredictably, some hypertrophic scars might settle and self-correct over several years.
Dr. Azzopardi advises that while some of these scars may settle spontaneously over several years, “many do not, especially if the original stimulus (often a wound healing under tension) does not subside”.
Keloid scars unfortunately are not known to settle and correct, and instead can continue to invade onto normal skin. Sometimes, the trigger for a keloid scar happens with very minor trauma, long after the main event.
Safae has a lot of experience with these kinds of keloids. “I have come across a lot of self-harm scars, knee scars or elbow scars that have turned into keloid scars. Patients have presented this to me at much later date of when the scar first appears, and often the scars are from teenage or childhood injuries. Due the length of time that it has been since the scar has presented itself, I would usually refer the patient to a dermatologist or specialist as this would require a medical intervention of potential steroid injections or advanced laser techniques.”
Can you prevent keloid and hypertrophic scars?
Due to how unpredictable they are, the greatest defense against these types of scars is to apply preventative measures.
Preventive therapies during or after any form of surgery include tactics like ensuring wound edges are together with minimum tension, hydrating the wound, taping, occlusion, and sometimes pressure garments.
For acne specific scars, treating your active acne properly can help prevent scar formation.
If you have any new scars, moisturising and sun protection become extremely important, as the loss of moisture from scars is quite different for a few months. Dr. Azzopardi advises “Premature exposure of immature scars to ultraviolet radiation (the sun) can also increase dyspigmentation and worsen the overall appearance. Sometimes, more invasive measures will be needed”, so be sure to protect yourself and moisturise regularly for the best results.
How do you remove keloids and treat hypertrophic scars? Can you flatten and get rid of them entirely?
While some hypertrophic scars do settle down after a period of rapid growth, this can take years. Due to how unpredictable they are, however, treatment of hypertrophic and keloid scars is a rapidly evolving landscape. Once you’ve exhausted all the measures of prevention above, the main advised course of treatment in the UK is to inject specific steroids to the scar.
Under specialist care, it may be possible to inject other medications, including botox, to stop the cells driving the keloid process and reduce any pain or itching around the scar area. In the right patient these can have amazing effects, but as every body is different it can be a case of trial and error. These medications can also be delivered through standard needle injection or through advanced machines that are compressed-air needle-free drivers, such as Enerjet™.
Further treatment options for keloid scars that are proving a little trickier to handle include surgery with injections to stop recurrence, and in very rare cases, liquid nitrogen freezing or radiotherapy.
Are there at-home remedies for keloid scars?
Unfortunately, at present, there aren’t any at-home remedies to address hypertrophic or keloid scarring, aside from the preventative moisturisation and SPF efforts that stop further growth.
How do laser treatment for hypertrophic and keloid scars work?
The main thing laser can do for hypertrophic and keloid scarring is help alter the colour appearance and texture of them.
Dr. Azzopardi says “in some cases, altering the vascularity or blood supply within the scar may also help mature the scar. Treating colour typically takes place over a number of sessions, to keep the energies delivered to a safe limit, and prevent triggering the keloid process again.”
Laser treatments can also be very important in helping larger hypertrophic scars which are forming sheets around the body or restricting your movement. For these, fractioned ablative laser should be used, where the laser beam has been split to microscopic beams, creating microscopic columns of vaporised tissue within the scar. Dr. Azzopardi says “The spacing of these columns with normal skin in between, allows rapid heat dissipation, and delivers enough energy to allow immediate changes in scar pliability with physiotherapy” which, at the same time, can instigate re-modelling in the scar. “It is also possible to use the tiny columns of vaporised tissue to improve access of medications applied to the skin. This process, called (LADD, or laser assisted drug delivery) is increasingly being reported as effective and safe.”
To improve the overall scar texture, you clinics would use a gentler, non-ablative fractioned laser like the Erbium-Glass.
There have also been exciting recent developments with the bare fiber subcutaneous laser, (Lasemar Eufoton ™ where a tiny laser fibre goes under the skin surface to help more effectively reach very deep parts of large keloids. For those suffering from very inflamed or infected keloids that are very difficult to treat, the new development shows promise and offers a different option.
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What are the potential complications of hypertrophic and keloid scar treatment?
It’s important to bear in mind that there are a number of potential complications to the treatments available, such as burns, infections, pain, discomfort, aggravation, over and under pigmentation. Your scar could become further concave and may have to be raised again.
Another thing to be aware of is that everyone’s skin is completely different, and depending on how you react to the treatments there could be little or no effect. The right device, specialist’s training and the type and staging of your scarring process, as well as the colour of your scar and skin and general medical condition will all come into play, so be sure to be happy with your consultation and agreed plan before you proceed with any treatments.
What’s the aftercare for hypertrophic/keloid scar treatment?
Having any tension on these scars in an absolute no-go. As with acne scars, Dr. Azzopardi advises that you should pay meticulous attention to moisturising your scar regularly, as well as to applying regular sun protection if you’re after an optimal result. As well as this, you should be sure to inform your medical professional: “Once a diagnosis is made confirming the type of scar you have, it is also important to alert your GP in case any surgery is needed in the future.”
- Expect some redness and slight swelling, as well as heat in the area during and after your treatment for the next two days
- Make sure to avoid saunas, steam rooms, the gym and any hot baths for at least 48hours post-treatment
- Avoid any perfumed products and resurfacing skincare items like retinol on the area for up to a week
- Avoid all tight and synthetic clothing on the area being treated, so it can breathe
- Be sure to wear suncream with a minimum SPF50 must be reapplied daily throughout the course of the treatment on the area that is exposed to any daily UV
How much does hypertrophic and keloid scar treatment cost?
This is a tricky one, as Safae advises, “it is important to consider that a single treatment rarely works.” You might need a whole range of different treatments, from injections to lasers or other methods. They’ll all depend entirely on your scar, its size and where it is, and the agreed program of treatment you decide on.