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Scars are an unfortunate fact of life. Their main purpose is to reconnect skin that has been injured. At first, they may be red or dark and rose after the wound has been cured but will become paler and flatter naturally over time, resulting in a flat, pale scar.

For reasons that are yet to be completely understood, some persons develop raised scars that are red and thick and may be itchy or painful. Others develop scars that grow beyond the site of an injury, called keloid scars.

Keloid scars are basically thick, itchy, puckered scars that grow beyond the limits of an injury or incision and rarely regress. They occur when the body keeps producing tough, fibrous protein (called collagen) after an injury has healed.

Keloid scars can result from any kind of injury to the skin, including bruises, tattoos, insect bites, injections or medical procedures, etc. Keloid scars can show anywhere on the body, but most commonly occur over the breastbone, on earlobes and on shoulders.

Keloids are fibrotic tumors characterized by a collection of atypical fibroblasts with high accumulation of extracellular matrix components, mainly elastin, collagen, fibronectin, and proteoglycans. Histologically, keloids have relatively acellular centers and thick, abundant collagen accumulations that create nodules in the deep dermal portion of the lesion. Keloids present a clinical problem that must be addressed as these lesions can produce great pain, pruritus (itch) and physical disfigurement, may not improve in appearance over time, and can even restrict mobility if located over a joint.

Unlike keloids, hypertropic scars are limited to the wounded site and usally flatten out over time. Hypertrophic scars can be hard to distinguish from keloid scars histologically and biochemically because both kinds accumulate larger amounts of collagen than normal scars. Both can be caused|the result of surgery, accidents and even acne.

Hypertrophic scars, however, will often show declining collagen synthesis after about six months. Hypertrophic scars have about twice as much glycosaminoglycans as normal scars, and this and increased synthetic and enzymatic reactions result in significant changes in the matrix which affects the mechanical properties of the scars, including minor extensibility that makes them feel firm.

As with hypertrophic scarring, persons having one keloid scar are likely to be prone to this scars in the future and should speak with their doctor or surgeon if they are likely to need injections or to have any kind of surgery.

Atrophic scars are recognized by a thinning and diminished elasticity of the skin due to a loss of regular skin architecture. An example of an atrophic scar is striae distensae, also called stretch marks. This type of scar can also be produced by acne lesions.

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