Patients often miscategorize their own scars most often labeling anything they don’t like as a keloid. In this blog post I will try to clarify some of the confusion about what is a keloid and what are other types of scars.
The ideal scar after any skin repair is flat, narrow, and white. Scars are never completely invisible but they can come quite close
Between the skin injury and the final scar, a process called “remodeling” occurs. Over varying periods of time, a scar will go through morphologic changes as the body manages the healing process. Scars are not categorized during remodeling as the outcome is often unknown. Almost all scars end up very favorable when the remodeling process is complete.
Here are scars in various stages of remodeling:
- Scars early in the remodeling process are thick and red. The red color indicates that the scar is biologically quite active. In spite of the fact that this is an unattractive state, it is not a keloid or hyper-tropic scar–at least not yet.
- After the first phase, scars go into the intermediate stage of remodeling. It still possesses some red color but not as intense as the early remodeling phase. In spite of the fact it does not look really good, it still may get much better with time. It is not yet time to give it a category.
- Next, the scar reaches the end of the remodeling process. It probably won’t have an ideal outcome, but time will tell. The redness is nearly gone but the scar is still a bit thick. It will not be a keloid, I assure you. It will probably end up flat but too wide.
A keloid is effectively a tumor of scar tissue, spilling out beyond the edges of the wound.
Most big scars are not keloids. A large and thick scar that does not exceed the borders of the injury is referred to as “hypertrophic.” Remodeling has ceased and the scar remains thick and wide. However, it is confined to the injured area so is a hypertrophic scar, not a keloid.
