A 45-year-old man develops a hypertrophic scar 3 months after a burn wound on the anterior chest. Which of the following correctly distinguishes a hypertrophic scar from a keloid, and which patient characteristic increases the risk of keloid formation?

• A Hypertrophic scar extends beyond wound margins; keloid remains confined; both are more common in fair-skinned individuals
• B Hypertrophic scar is confined to the wound margins and may regress spontaneously; keloid extends beyond margins and does not regress; darker-pigmented skin carries higher risk of keloid ✓
• C Keloid is confined to the wound; hypertrophic scar extends beyond and is more amenable to steroid injection
• D Both keloid and hypertrophic scars are characterised by excessive Type I collagen deposition; only keloids contain myofibroblasts

Explanation

The key distinction: hypertrophic scars remain within the original wound boundaries, may regress over 12–24 months, and respond well to pressure garments and intralesional corticosteroids. Keloids extend beyond the original wound margins, do not regress spontaneously, and are poorly responsive to standard treatment. Keloids are significantly more prevalent in individuals with darker skin pigmentation (Fitzpatrick types V–VI), particularly of African, Caribbean, or Asian descent, with a 5–15× higher incidence. Both contain excess Type III and Type I collagen; myofibroblasts are involved in both but are more persistent in keloids. Steroid injection can treat both but is more predictably effective for hypertrophic scars.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.