Keloid and Hypertrophic Scars

What are keloid and hypertrophic scars?

Keloid and hypertrophic scars are common types of scarring that can occur as a result of the acne healing process. They appear as raised lesions of scar tissue on the skin and are a result of the overgrowth of fibrous tissue in the region where the acne lesion had developed.

They are more common on the chest, back and shoulders, where the skin is thicker, although they can occur around the jaw line. They are also more common in people with darker skin types.

What is the difference between keloid and hypertrophic scars?

The difference between keloid and hypertrophic scars is their size in relation to the acne lesions that caused them. A keloid scar is larger than the acne lesion that caused it. A hypertrophic scar is the same size as the acne lesion that caused it.

What factors make it more likely that keloid and hypertrophic scars will form?

Like all acne scars, the formation of keloid and hypertrophic scars is largely dependent on how your skin heals. If you tend to scar easily then you are more likely to develop acne scars.

Inflammation also plays a key role in development of acne scars. The deeper that inflammation from an acne lesion reaches into the skin the more likely it is to scar upon healing. This is one of the reasons that it is important to treat acne as soon as possible, to lower the risk of deep inflammation.

Picking or squeezing acne lesions can damage the skin and lead to an increased chance of scarring. It is not advised that you pick at or squeeze your acne. However, in reality many people do this in an attempt to remove pus. If you are insistent on picking at or squeezing your acne to remove pus then please see our guide on how to lower your chances of damaging your skin here.

You are also more likely to develop acne scars if you smoke, as smoking leads to an increased risk of scarring in general.

People with darker skin types are also at a higher risk of developing thicker keloid and hypertrophic scars as they have a variety of genetic factors that increase the likelihood of thickened scars occurring.

Keloid and Hypertrophic Scar Treatments

Treatment for keloid and hypertrophic scarring comes in two stages, as it does for other acne scarring. First stage treatments for keloid and hypertrophic scarring are designed to reduce the height of the scar so that the skin’s surface returns to being flat. Second stage treatments for keloid and hypertrophic scarring are aimed at reducing skin discolouration in the newly flat scar.

It is important to remember that scar reduction treatments are not readily available on the NHS. If you are thinking about paying for a scar reduction treatment privately then be sure to research your practitioner and make certain that they are qualified to conduct the procedure, such as a Consultant Dermatologist or Plastic Surgeon. It is often advisable to use a practitioner who can carry out all of the various forms of scar reduction treatments that are discussed above, as they will be able to advise you on the best option for your skin colour and nature of scarring.

Please note that all of the treatments below have potential side effects, such as burns, skin peeling, irritation, skin bleaching and changes to skin texture. Darker skin types are at higher risk of suffering the side effects of scar removal. Please talk to your healthcare provider to find out more about the risks involved for any treatment that you may be considering.

Stage One Treatments

Steroid Injections

This is where steroids are injected directly into the scar to soften and thin the fibrous tissue, lowering the scar’s height. It often takes several steroid injections spaced 4 to 6 weeks apart to achieve the best results.

Dermabrasion

This is where a special tool is used to remove the top layers of skin through friction, not unlike a sanding machine. As the layers of skin are removed the keloid or hypertrophic scar becomes flatter.

Chemical Peels

This treatment works by removing the outer layers of skin using high concentrations of glycolic or salicylic acid.

Laser Therapy

Laser therapies work in two ways. Ablative laser therapy uses high energy light to remove the outer layers of skin whilst encouraging new collagen production in the lower layers of skin. Non-ablative laser therapy uses heat to encourage new collagen production in the skin without damaging the outer layer. The removal of the outer layers and/or the production of new collagen results in a reduction in scar height. There are multiple laser therapies that are available for the treatment of acne scarring. A consultant dermatologist will be able to determine which treatment is right for you based on your skin colour and the nature of your scarring.

Stage Two Treatments

Dermabrasion

This is where a special tool is used to remove the top layers of skin through friction, not unlike a sanding machine. As the layers of skin are removed the discolouration caused by scarring can become reduced.

Microneedling

This treatment is sometimes known as collagen induction therapy. It works by using a special tool to create several, tiny injuries within a scar. These injuries usually heal within two days and new collagen is formed inside of the scar. Collagen is a protein that help gives our skin strength and elasticity. Through this process microneedling can reduce the discolouration associated with scarring by encouraging old skin cells to shed, including skin cells that have been discoloured by excess pigment. Multiple treatments tend to be required every four-six weeks to gain maximum benefits. It is important to note that reducing skin discolouration is not microneedling’s main purpose and targeted treatments designed for treating skin discolouration may work better.

Chemical Peels

This treatment works by removing the outer layers of skin using high concentrations of glycolic or salicylic acid. In doing so, it can reduce the discolouring that is associated with scarring. This treatment should only be carried out by a qualified practitioner (visit www.jccp.org.uk).

Laser Therapy

Ablative laser therapy uses high energy light to remove the outer layers of skin, which can reduce the discolouration that is associated with scarring. There are multiple laser therapies that are available for the treatment of acne scarring. A consultant dermatologist will be able to determine which treatment is right for you based on your skin colour and the nature of your scarring.