A hypertrophic scar develops 3 months after a forearm laceration. Which statement correctly distinguishes it from a keloid scar?

• A Hypertrophic scars extend beyond the original wound margins and rarely regress spontaneously
• B Keloid scars are more common in Caucasians and respond well to simple excision
• C Both hypertrophic and keloid scars are caused by excessive type I collagen; there is no reliable clinical distinction
• D Hypertrophic scars are confined within the wound margins, may regress spontaneously, and occur at any anatomical site ✓

Explanation

Hypertrophic scars remain confined within the original wound boundaries, are raised, erythematous, and may spontaneously regress over 12-18 months. They occur at any site but are more common in areas of high tension. Keloid scars extend beyond the original wound margins ('crab claw' appearance), do not regress, and recur after simple excision — hence excision alone is contraindicated and should be combined with intralesional corticosteroid, pressure garments, or radiotherapy. Keloids are more common in darker-skinned individuals and have a genetic predisposition. Biochemically, both show increased TGF-β1 activity and collagen overproduction.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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