Keloid and hypertrophic scars: description, types, causes and treatment

After any trauma on the skin, a person has a memorable sign in the form of a scar, which in German means "scar". Sometimes these marks do not cause problems, either they are not in a prominent place, or almost indistinguishable from neighboring skin areas. But there are situations when the scars are too noticeable, convex, dark, sometimes with a highly corrugated surface. These are hypertrophic and keloid scars. Of course, they are a significant cosmetic defect, especially if located on the face, neck, chest. Getting rid of them is not so easy, because this kind of scars has a special fiber structure that is difficult to correct.

Types of scars

In some people, wounds are delayed quickly and almost painlessly. In others, this process is stretched for weeks, and when, finally, the wounds heal, in place of their ugly rough marks remain. Different "behavior" of tissues depends on many factors, for example, from infection of wounds, their location (mobile site or not), the size and depth of damage, the individual ability of the body to regenerate, the type of skin and so on. The combination of all these causes leads to the fact that in some cases, the scars are obtained as if sunk (they are called atrophic), while in others they are on the same level as the skin layers (normotrophic ones).

The most problematic, from the position of cosmetology, are hypertrophic scars. They appear, when in the healing tissues of the wound fibroblasts become too active and begin to intensify the synthesis of collagen. In this case, the enzyme collagenase, which destroys excess collagen, is produced in insufficient quantities. As a result of the new tissue, too much is formed. To go to surpluses there is no place, and they stick out above the healed place of damage. The height of such scars can reach 10 mm. Their color is generally darker than the skin in neighboring areas, and the surface often has a rough terrain.

Keloids

These formations are externally very similar to hypertrophic scars, but they have a number of unpleasant differences. The main thing is that keloid scars, appearing at the site of injury, expand into undamaged skin areas. The starting mechanism for them can be either a large cut or a burn, or a minor injection, even an insect bite, to which many do not pay attention. The keloid scar begins to grow a month or more after wound healing. Growth can last up to two years, after which the stabilization phase begins. In histological studies in keloids too active giant fibroblasts, continuously producing collagen, are detected. And if hypertrophic scars, though ugly, but painless, then keloid can cause itching, pain, increased sensitivity of the skin. Distinguish false keloids appearing at the site of trauma, and true, which occur where the skin is not outwardly damaged.

Treatment of keloid and hypertrophic scars

To date, the following methods of correction of gross scars are used:

• compression;
• Silicone preparations (plates, gel);
• Laser therapy;
• surgical intervention;
• radiation therapy;
• Cold treatment;
• Drug therapy;
• Corticosteroids.

Any of them has its advantages and disadvantages. Which of the methods to apply, in each case should be decided by the doctor. To remove hypertrophic, and furthermore keloid scars, which are often diagnosed as dermatofibroma and even infiltrating cancer, are necessary only in specialized clinics.

Surgical intervention

Hypertrophic and keloid scars are rarely removed surgically, because after such a correction there is almost always a relapse. For example, if we talk about keloids, the defect recovery takes place in 80-90% of all reported cases and manifests itself in the formation of scar tissue even larger than before removal. In the case of hypertrophic scars, the percentage of complications is somewhat lower. Surgical correction is best tolerated by narrow scars with distinct edges. During the operation, the surgeon cuts them, compares the edges of the incision, makes an internal seam, which is barely noticeable. This operation is performed under local anesthesia. Hospitalization is not required.

If extensive scars are removed by the surgical procedure, for example, burns, do a patchwork of the skin (transplant).

Compression

Hypertrophic scars in this way practically do not correct, but in the case of keloids it gives satisfactory results. The essence of the method consists in applying a tight bandage to the place of the scar, which the patient wears, without removing, from 3 months to a year. Sometimes the dressing can be applied every 12 hours. Due to pressure on the vessels of the rumen, its nutrition ceases. Simultaneously, the edges of the scar tissue are squeezed, which prevents its further growth.

Radiation therapy

This method is considered the most effective and is used all over the world. Removal of hypertrophic scars, keloids and other formations on the skin is carried out by the so-called beech rays (X-ray radiation with the help of high-precision beta-applicators). As a result, fibroblasts are destroyed or stopped, the synthesis of collagen ceases. Beams of different intensity can be used.

In any case, 90% of them absorb the upper layers of the skin, and only 10% fall into the dermis. Often this method is used in conjunction with surgical removal of the scar. Relapses after such therapy are registered in 50% of cases. Due to the special effects of X-ray radiation, the method is not used to remove scars in the head, neck and chest area. Contraindications:

• oncology;
• diabetes;
• Heart and vascular disease;
• Exacerbation of various diseases.

Cryotherapy

This is one of the safest and most effective methods. Keloids without relapses with cold help completely disappear in 51% of cases. And in 76% of cases, hypertrophic scars are removed . Treatment should be complex (cryotherapy and other methods - the use of ointments, silicone), then it makes sense to hope for almost complete (90%) disappearance of scars, without complications and relapses. The essence of the method lies in the effect on the scar of liquid nitrogen (a temperature of about -196 ° C). It is applied with a tampon or with a special applicator. As a result, ice crystals form in the cells, the cytoplasm and organelles die. So fibroblasts are destroyed, the synthesis of collagen stops. Exposure to nitrogen lasts a maximum of 30 seconds, but most often it takes 5 seconds. To completely remove the scar, several procedures are sufficient. Disadvantages of the method:

• Painful procedure;
• The possibility of the formation of a blister at the site of the rumen;
• Hyperpigmentation after the procedure.

Treatment with silicone

Now the pharmaceutical companies have developed gels containing silicone, and special silicone plates. The principle of action of the drugs is approximately the same - they serve to maximize the hydration and softening of the body of the scars, blocking the access of oxygen to its fibers and reducing the synthesis of collagen.

This method removes atrophic and hypertrophic scars. For the treatment of keloids, it does not fit. Plates are produced in different shapes and sizes. On the one hand, they have an adhesive coating, providing the most dense adherence to the scar. Their structure is such that they pass air to the skin, while being waterproof. Advantages of the method are ease of use, relatively low price, painlessness and absence of complications, allergies, side effects. Disadvantages: duration of the procedure (several months) and low effect.

Corticosteroids

Many people ask how to remove the hypertrophic scar quickly and with a noticeable effect. Injections of prolonged (with a long period of action) corticosteroids fulfill these desires of patients, and good results are also achieved in the treatment of keloids. To date, the corticosteroids "Kenalog" and "DiPisan" are used. The mechanism of their action is approximately the same and consists in reducing the number of leukocytes and cytokines, suppressing the growth factor and necrosis of growth, inhibiting the work of fibroblasts, removing allergic reactions, reducing the level of collagen. The procedure is carried out once every 10-14 days. Side effects:

• Hypopigmentation;
• The penetration of a reticulum of capillaries on the skin;
• The appearance of steroid acne;
• Thinning of the skin;
• General negative impact on the body.

To reduce side effects, corticosteroids are injected together with lidocaine (1: 5), saline, pentoxifylline. An excellent result is provided by this procedure in conjunction with cryotherapy.

Laser Therapy

Grinding hypertrophic scar or keloid with a laser gives the maximum effect. The essence of the procedure consists in a neat and very precise removal of the upper layer of the skin and scar tissue. As a result, the skin is renewed, a new elastin and collagen are formed in the treated area, the convexity of the scar is reduced, it is practically compared with the surrounding veils. After applying this method, hypertrophic scars completely disappear in 80-95%, and keloid scars in 60-70% of cases. Complications after the procedure:

• Edema;
• hyperemia;
• Increased sensitivity of the skin to sunlight;
• erythema;
• Hyperpigmentation (passes without treatment);
• acne;
• Formation of cysts.

The laser effect is ambulatory (deeper) and non-ablative (more sparing). In the second case, complications are usually less, but the duration of treatment is longer.

Medication Therapy

There is an external treatment and through the introduction of medication into the body of the rumen. For injections, preparations based on hyaluronidase (an enzyme, due to which hypertrophic scars become less edematous, soft, their relief flattened) are used. These include "Lidase", "Alidaza", "Longidasa", "Volidaz" and others. Injections should be done every day or every 2 days for 1-2 weeks. Disadvantages of the method:

• Instability of the enzyme;
• Adverse reactions;
• Allergenicity.

For external treatment use ointments, creams, sprays. In pharmacies, there is a wide selection of drugs that remove scars. The most popular are Kontraktubeks, Dermatics, Kelo-Kot, Kelobibraza. Advantages of the method are its ease, the ability to be treated at home, the absence of side effects. Disadvantages - in low efficiency.

Against keloid scars, ointments and injections are of little help, and treatment is only complex.

How to avoid the appearance of gross scars

If the wound is too large, the scar, one way or another, will remain. But in some cases, you can try to minimize its appearance. So, the hypertrophic scar after removal of the birthmark is almost never formed, if the procedure is performed by cryotherapy, electrocoagulation, using a laser. If the birthmark is removed surgically, the scar remains always. And if you remove it yourself, at home, the inflammatory process may begin, which will further exacerbate the situation.

With any injury to the skin, so that the wound heals better and faster, you must follow certain rules:

• Do not allow dirt to get on the injured skin;
• Avoid friction and touching the wound surface (for example, clothes);
• In no case do not rip off the crusts formed;
• Cover the wound from direct sunlight;
• Use special creams that help quick healing and reduce the risk of scars (one of the best among such drugs is "Kontraktubeks").