So what is a keloid scar?

Normal and hypertrophic scars are similar in terms of their ‘cycle’ of matrix proliferation, stabilization, and maturation. Keloid scars rarely ‘mature,’ but there are gross morphologic differences between mild and severe keloids. A diagrammatic representation of hypertrophic and keloid scars demonstrates one essential clinical difference - contraction. Diagram reproduced with permission.⁴

A hypertrophic scar before (a) and after (b) excision. Note contraction deformity (hyper extension) of little finger MCPJ corrected by excision.

A keloid scar before (a) and after (b) excision. Note no deformity of mouth before or after excision.

a) Mild keloids caused by repeated ear piercing in a Chinese boy. b) A massive keloid caused by ear piercing in an African girl (provided courtesy of Dr Richard Nnabuko).

a) Post burn ear showing classical keloid but also post-auricular hypertrophic scar. b) The keloid was shaved and cell spray applied. The blue colour is gentian violet applied 3 weeks post-cell spray. c) Three year follow up after keloid removal. All scars mature and no recurrence of keloid.