Fundamentals of Pathological Scarring

Pathological scarring sometimes occurs after a wound has healed. There are two main types of pathological scars: keloid scars and hypertrophic scars. A keloid scar is a fibroproliferative disorder of the dermis that arises from abnormal healing processes after a skin injury, extending excessively and invasively into the surrounding tissues. Multiple factors, such as demographics, genetics, lifestyle, and local and systemic factors, influence its development. Although not considered a true neoplasm, a keloid presents some similar properties (uncontrolled growth, invasion of the neighboring tissues, the absence of spontaneous remission, and vascularization capacity). Its diagnosis is established by clinical examination, highlighting its characteristic feature of scarring that exceeds the original wound edges and its frequent association with symptoms such as pain and pruritus. The type of treatment for keloids (mono- or multimodal therapy; invasive or non invasive treatment) depends on their size and number. Hypertrophic scars are similar to keloid scars, except that their growth is restricted within the limits of the original skin defect and might be more responsive to treatment.