A 40-year-old man develops a hypertrophic scar 6 months after a burn injury. What is the pathological distinction between a hypertrophic scar and a keloid?

• A Hypertrophic scar grows beyond the wound margins; keloid stays within wound boundaries
• B Keloid occurs only in dark-skinned individuals; hypertrophic scars occur in all skin types
• C Hypertrophic scar stays within wound margins and may regress; keloid extends beyond wound boundaries and rarely regresses ✓
• D Hypertrophic scars have no collagen; keloids are collagen-rich

Explanation

The key distinction between hypertrophic scars and keloids: hypertrophic scars remain within the boundaries of the original wound, may be raised and erythematous, but tend to regress over time (months to years). Keloids extend beyond the original wound margins into surrounding normal skin, have continuous growth potential, rarely regress spontaneously, and are more common in darker-skinned individuals and at certain body sites (earlobes, sternal region, deltoid). Both are treated with silicone sheets, pressure therapy, or intralesional steroids, but keloids have much higher recurrence rates after treatment.

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

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Written and medically reviewed by the StethoPrep medical team.