A 35-year-old man develops a hypertrophic scar 3 months after a burn injury. Comparing hypertrophic scar versus keloid, which statement is CORRECT?

• A Hypertrophic scar extends beyond wound margins; keloid stays within wound boundaries
• B Keloid extends beyond wound margins; hypertrophic scar stays within wound boundaries ✓
• C Both keloid and hypertrophic scar are caused by type I collagen deficiency
• D Keloid is always associated with burn injury whereas hypertrophic scar occurs after any wound

Explanation

Keloids are characterized by exuberant fibroproliferation that extends beyond the original wound margins (invasive growth), do not regress spontaneously, and have a high recurrence rate after excision alone. They are more common in dark-skinned individuals and genetically predisposed patients, occur on the earlobe, sternum, and upper back. Hypertrophic scars remain confined within the original wound boundaries, may spontaneously regress over 1-2 years, and have a better prognosis. Both involve excess type III collagen in early phases and type I collagen in mature scars, but TGF-β1-driven fibroblast activity is more pronounced in keloids. Silicone sheeting and compression reduce both types.

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

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Written and medically reviewed by the StethoPrep medical team.