• What is Scarring
• Hypertrophic Scarring
• Keloid Scarring
• Who gets Keloid Scarring
• Where people get Keloid Scarring
• What they look like
• Keliods in History

What is Scarring

When the skin is cut through its full thickness, it responds by undergoing a process of wound healing where a SCAR is formed. This process is demonstrated in the diagrams below. Scars can take up to months to properly form, but initially when the skin is cut it bleeds and a blood clot is formed, this may be seen on the skin as a scab. As the clot forms cells known as FIBROBLASTS are attracted to it, and move towards the clot from the surrounding skin and tissue. They work by breaking down the clot and replacing it with a protein called COLLAGEN. Collagen is an important protein within the human body, and between 25-35% of the bodies protein is Collagen, it is part of the proteins which make up normal skin. Fibroblasts produce collagen which replaces the blood clot and forms a scar instead, the way this collagen is produced differs from the way normal skin is produced, and because of this scar tissue looks different to normal skin. Due to the different ways scars form the scar tissue is not as functional as normal skin and sweat glands and hair follicles are not able to grow back on scar tissue.

In humans scarless regeneration of skin and other organisms can be seen in utero, and an injured foetus will not scar, although once born this changes. Scarring in general is a very personal thing and some people naturally scar better than others, sadly there is no way we can predict how someone will scar.

What is Keloid Scarring

There is a whole range of different ways in which people scar, the poorest types of scarring are Hypertrohic and Keloid Scarring.

Hypertrophic Scarring

This is a form of heavy scarring that appears around a wound; this type of scarring would be slightly raised, red and perhaps itchy for a few months, importantly the scar will never be bigger than the wound itself. These generally become flatter and paler with time. Hypertrophic scars develop within a month of receiving the wound and may take several months to retract.

Keloid Scarring

These may be similar at first but whereas a hypertrophic scar will not go outside of the boundaries of the wound a Keloid scar would, patients can have a single keliod or a number of them. Keloid scars do not stop growing and spread outwards away from the site of the original wound and the scar can often become far bigger than the actual wound. The exact causes of keloids is not fully understood, but it is an abnormality of wound healing. A problem in Keloid scarring is that the fibroblasts that produce collagen to make a scar, over produce collagen and the keloid continues to grow. They may not appear right away and can often begin to develop months after the initial wound has been made. Keloids are made up of dense fibrous tissue (made up of collagen), where the collagen fibres are both thicker and bigger than those found in normal scarring.

In normal scarring the scar you get is dependent upon the wound, Keloids differ and in people susceptible to them they can occur after very minor skin damage such as piercings, acne spots, cuts from shaving and even scratching. Keloids are usually hairless and raised, they may be shiny and when you feel them can be hard and rubbery. The number of keloids someone can get can vary, from one or two to many depending. These can be diagnosed by Doctors just by looking and examining them. It is important to remember that Keloids are not contagious and are totally benign and there is no risk of these becoming cancerous.

Examples of Keloids

Who gets Keloid Scarring

Anyone at any age can get keloid scarring. But studies have shown that there are some skin types and ages were keloids are more common and it has been found that there is a higher occurance of keloids between the ages of Keloids 10 and 30 years, with the average age of keloid sufferers being in their early 20's they are not so common in the ederly and children, and equally common in men and women, although women in general may have more keloids due to a higher incidence of piercings.

It has also been found that certain skin types are also more susceptible to Keloid formation. With there being a higher incidence in both darker skin types such as Afro-Carribeans and South Asians and well as very fair individuals, up to15% of darker skinned ethnicities are at risk of developing keloids.. The Fitzpatrick skin classification split up skin types into 6 groups (demonstrated below) and it is thought that individuals at either extreme of this scale may be more susceptible to keloid scarring. Although it is important to note that any skin type can still develop keloids. Family history is also important and currently evidence is pointing to there being a genetic cause involved in keloid formation, and if a family member has them you are more likely to develop them and even more so if a twin has developed keloids.

Where people get Keloid Scarring

Keloids can occur anywhere where there is trauma to the skin and are frequently seen in locations where there have been piercings such as the ear lobes. It is thought that stretching of the skin may increase keloid formation where a wound has occurred, and sites where keloids commonly form are often subject to stretching and tension with the exception of the ear where there are piercings. Otherwise they can occur commonly on the front of the chest, neck, shoulder, scapular and suprapubic region (the area between your groin and your stomach). It is also possible for keloids to occur spontaneously, these also can be anywhere but have a pre-disposition of occurring on the chest.

What they look like

The majority of the symptoms caused by keloids are cosmetic but the scar can sometimes be tender to touch and painful, especially around the edges. It may also be itchy and occasionally bleed.

Keliods grow outside the boundaries of the original site of trauma and is likely to raised, it often feels rubbery, is shiny and irregular. The colour of the keloid can often change with time and usually is red in the early stages and changes with agebecoming paler and brown.

If the keloid is over a joint, such as the elbow or knee it can also restrict movement.

Keloids can continue growing from months to years, and although growth is usually slow it can be rapid in some patients. Although they do not regress spontaneously without treatment they may stop growing.

Keliods in History

Keloids were described by Egyptian surgeons around 1700 BC. Evidence of this was discovered by the english archaeologist Edwin Smith in 1930 when he translated a papyrus from ancient Eygpt detailing surgery at that time. There is also evidence that the South American Olmec tribes whom lived in what is now Mexico in around 1500-1000 BC, used keloid and hypertrophic scarring as a means of body decoration.

The actual term Keloid was defined by French Dermatologist Baron Jean Louis Alibert in 1806. "Cheloide" was used by Alibert and is derived from the Greek word chele, meaning crab's claw. Scarring for decoration is still used today in parts of Africa, where certain tribes try to make keloid tattoos on the face by cutting various patterns onto themselves.