Laboratory Studies

Diagnosis is usually based on clinical findings. Biopsy may confirm the diagnosis in equivocal cases.

Other Tests

There is no objective method or reliable device to measure and assess the physical properties of keloids and hypertrophic scars, and they have generally been assessed subjectively using the Vancouver burn scar scale. A novel device, the Vesmeter, was recently studied by Niyaz et al for the quantification of the physical properties of keloids and hypertrophic scars.^[3]Simultaneous automatic assessment of 6 physical properties were made (ie, skin elasticity, viscosity, viscoelastic ratio, penetration depth, relaxation time, hardness) is performed while the sensor is in contact with the lesion. Data are transmitted to a personal digital assistant (electronic handheld information device) via Bluetooth.

The most important advantages demonstrated of the Vesmeter were its ability to measure the physical properties of keloids and hypertrophic scars at any point during the clinical course and digitalize the data and its capability to evaluate clinical improvement or deterioration after a given treatment. Vesmeter was demonstrated to be sensitive and can detect very slight changes in skin hardness and elasticity.

Histologic Findings

Formation of collagen in keloids and hypertrophic scars in the inflammatory stage takes much longer than usual in healing wounds. Collagen fibers in granulation tissue are arranged in a whorled pattern. In keloids, the nodules demonstrate thick, hyalinized bands in the central portion of the nodule. Note the images below.

Histology of keloid demonstrating central zone of hyalinized collagen (hematoxylin and eosin stain). Courtesy of Dirk M. Elston, MD.

View Media Gallery

Histology of keloid demonstrating thick hyalinized collagen bundles (hematoxylin and eosin stain). Courtesy of Dirk M. Elston, MD.

View Media Gallery

Treatment & Management

Kischer CW, Brody GS. Structure of the collagen nodule from hypertrophic scars and keloids. Scan Electron Microsc. 1981. 371-6. [QxMD MEDLINE Link].
Luo L, Li J, Liu H, Jian X, Zou Q, Zhao Q, et al. Adiponectin Is Involved in Connective Tissue Growth Factor-Induced Proliferation, Migration and Overproduction of the Extracellular Matrix in Keloid Fibroblasts. Int J Mol Sci. 2017 May 12. 18 (5):[QxMD MEDLINE Link].
Niyaz A, Matsumura H, Watanabe K, Hamamoto T, Matsusawa T. Quantification of the physical properties of keloid and hypertrophic scars using the Vesmeter novel sensing device. Int Wound J. 2012 Dec. 9(6):643-9. [QxMD MEDLINE Link].
Hsu KC, Luan CW, Tsai YW. Review of Silicone Gel Sheeting and Silicone Gel for the Prevention of Hypertrophic Scars and Keloids. Wounds. 2017 May. 29 (5):154-158. [QxMD MEDLINE Link].
Li Z, Dranoff JA, Chan EP, Uemura M, Sevigny J, Wells RG. Transforming growth factor-beta and substrate stiffness regulate portal fibroblast activation in culture. Hepatology. 2007 Oct. 46(4):1246-56. [QxMD MEDLINE Link].
Peyton SR, Putnam AJ. Extracellular matrix rigidity governs smooth muscle cell motility in a biphasic fashion. J Cell Physiol. 2005 Jul. 204(1):198-209. [QxMD MEDLINE Link].
Hayashi T, Furukawa H, Oyama A, et al. A new uniform protocol of combined corticosteroid injections and ointment application reduces recurrence rates after surgical keloid/hypertrophic scar excision. Dermatol Surg. 2012 Jun. 38(6):893-7. [QxMD MEDLINE Link].
Al Aradi IK, Alawadhi SA, Alkhawaja FA. Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg. 2013 Oct. 39(10):1514-9. [QxMD MEDLINE Link].
Huang L, Cai YJ, Lung I, Leung BC, Burd A. A study of the combination of triamcinolone and 5-fluorouracil in modulating keloid fibroblasts in vitro. J Plast Reconstr Aesthet Surg. 2013 Sep. 66(9):e251-9. [QxMD MEDLINE Link].
Torii K, Maeshige N, Aoyama-Ishikawa M, Miyoshi M, Terashi H, Usami M. Combination therapy with butyrate and docosahexaenoic acid for keloid fibrogenesis: an in vitro study. An Bras Dermatol. 2017 Mar-Apr. 92 (2):184-190. [QxMD MEDLINE Link].
Berman B, Flores F. Interferons. Wolverton SE, ed. Comprehensive Dermatologic Drug Therapy. Philadelphia, Pa: WB Saunders; 2001. 339-57.
Torkian BA, Yeh AT, Engel R, Sun CH, Tromberg BJ, Wong BJ. Modeling aberrant wound healing using tissue-engineered skin constructs and multiphoton microscopy. Arch Facial Plast Surg. 2004 May-Jun. 6(3):180-7. [QxMD MEDLINE Link].
Conejo-Mir JS, Corbi R, Linares M. Carbon dioxide laser ablation associated with interferon alfa-2b injections reduces the recurrence of keloids. J Am Acad Dermatol. 1998 Dec. 39(6):1039-40. [QxMD MEDLINE Link].
Lee JH, Kim SE, Lee AY. Effects of interferon-alpha2b on keloid treatment with triamcinolone acetonide intralesional injection. Int J Dermatol. 2008 Feb. 47(2):183-6. [QxMD MEDLINE Link].
Wittenberg GP, Fabian BG, Bogomilsky JL, et al. Prospective, single-blind, randomized, controlled study to assess the efficacy of the 585-nm flashlamp-pumped pulsed-dye laser and silicone gel sheeting in hypertrophic scar treatment. Arch Dermatol. 1999 Sep. 135(9):1049-55. [QxMD MEDLINE Link].
al-Khawajah MM. Failure of interferon-alpha 2b in the treatment of mature keloids. Int J Dermatol. 1996 Jul. 35(7):515-7. [QxMD MEDLINE Link].
Davison SP, Mess S, Kauffman LC, Al-Attar A. Ineffective treatment of keloids with interferon alpha-2b. Plast Reconstr Surg. 2006 Jan. 117(1):247-52. [QxMD MEDLINE Link].
Pittet B, Rubbia-Brandt L, Desmouliere A, et al. Effect of gamma-interferon on the clinical and biologic evolution of hypertrophic scars and Dupuytren's disease: an open pilot study. Plast Reconstr Surg. 1994 May. 93(6):1224-35. [QxMD MEDLINE Link].
Kontochristopoulos G, Stefanaki C, Panagiotopoulos A, et al. Intralesional 5-fluorouracil in the treatment of keloids: an open clinical and histopathologic study. J Am Acad Dermatol. 2005 Mar. 52(3 Pt 1):474-9. [QxMD MEDLINE Link].
Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg. 2004 Jan. 30(1):54-6; discussion 56-7. [QxMD MEDLINE Link].
Darougheh A, Asilian A, Shariati F. Intralesional triamcinolone alone or incombination with 5-fluorouracil for the treatment of keloid and hypertrophicscars. Clin Exp Dermatol. Mar/2009. 34(2):219-23. [QxMD MEDLINE Link].
Asilian A, Darougheh A, Shariati F. New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars. Dermatol Surg. 2006 Jul. 32(7):907-15. [QxMD MEDLINE Link].
Manuskiatti W, Fitzpatrick RE, Goldman MP. Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser. J Am Acad Dermatol. 2001 Oct. 45(4):557-65. [QxMD MEDLINE Link].
Goldan O, Weissman O, Regev E, Haik J, Winkler E. Treatment of postdermabrasion facial hypertrophic and keloid scars with intralesional 5-Fluorouracil injections. Aesthetic Plast Surg. 2008 Mar. 32(2):389-92. [QxMD MEDLINE Link].
Sadeghinia A, Sadeghinia S. Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatol Surg. Jan/2012. 38(1):104-9. [QxMD MEDLINE Link].
Saha AK, Mukhopadhyay M. A comparative clinical study on role of 5-flurouracil versus triamcinolone in the treatment of keloids. Indian J Surg. 2012 Aug. 74(4):326-9. [QxMD MEDLINE Link].
Saray Y, Gulec AT. Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study. Int J Dermatol. 2005 Sep. 44(9):777-84. [QxMD MEDLINE Link].
Muszynska A, Palka J, Gorodkiewicz E. The mechanism of daunorubicin-induced inhibition of prolidase activity in human skin fibroblasts and its implication to impaired collagen biosynthesis. Exp Toxicol Pathol. 2000 May. 52(2):149-55. [QxMD MEDLINE Link].
Muszynska A, Palka J, Wolczynski S. Doxorubicin-induced inhibition of prolidase activity in human skin fibroblasts and its implication to impaired collagen biosynthesis. Pol J Pharmacol. 1998 Mar-Apr. 50(2):151-7. [QxMD MEDLINE Link].
Muszynska A, Wolczynski S, Palka J. The mechanism for anthracycline-induced inhibition of collagen biosynthesis. Eur J Pharmacol. 2001 Jan 5. 411(1-2):17-25. [QxMD MEDLINE Link].
Espana A, Solano T, Quintanilla E. Bleomycin in the treatment of keloids and hypertrophic scars by multiple needle punctures. Dermatol Surg. 2001 Jan. 27(1):23-7. [QxMD MEDLINE Link].
Bodokh I, Brun P. [Treatment of keloid with intralesional bleomycin]. Ann Dermatol Venereol. 1996. 123(12):791-4. [QxMD MEDLINE Link].
Sandulache VC, Parekh A, Li-Korotky H, Dohar JE, Hebda PA. Prostaglandin E2 inhibition of keloid fibroblast migration, contraction, and transforming growth factor (TGF)-beta1-induced collagen synthesis. Wound Repair Regen. 2007 Jan-Feb. 15(1):122-33. [QxMD MEDLINE Link].
Naeini FF, Najafian J, Ahmadpour K. Bleomycin tattooing as a promising therapeutic modality in large keloids and hypertrophic scars. Dermatol Surg. 2006 Aug. 32(8):1023-9; discussion 1029-30. [QxMD MEDLINE Link].
Aggarwal H, Saxena A, Lubana PS, Mathur RK, Jain DK. Treatment of keloids and hypertrophic scars using bleom. J Cosmet Dermatol. 2008 Mar. 7(1):43-9. [QxMD MEDLINE Link].
Manca G, Pandolfi P, Gregorelli C, Cadossi M, de Terlizzi F. Treatment of keloids and hypertrophic scars with bleomycin and electroporation. Plast Reconstr Surg. 2013 Oct. 132(4):621e-630e. [QxMD MEDLINE Link].
Camacho-Martinez FM, Rey ER, Serrano FC, Wagner A. Results of a combination of bleomycin and triamcinolone acetonide in the treatment of keloids and hypertrophic scars. An Bras Dermatol. 2013 May-Jun. 88(3):387-94. [QxMD MEDLINE Link].
Copcu E, Sivrioglu N, Oztan Y. Combination of surgery and intralesional verapamil injection in the treatment of the keloid. J Burn Care Rehabil. 2004 Jan-Feb. 25(1):1-7. [QxMD MEDLINE Link].
D'Andrea F, Brongo S, Ferraro G, Baroni A. Prevention and treatment of keloids with intralesional verapamil. Dermatology. 2002. 204(1):60-2. [QxMD MEDLINE Link].
Shah M, Foreman DM, Ferguson MW. Neutralisation of TGF-beta 1 and TGF-beta 2 or exogenous addition of TGF-beta 3 to cutaneous rat wounds reduces scarring. J Cell Sci. 1995 Mar. 108 (Pt 3):985-1002. [QxMD MEDLINE Link].
Lawrence WT. Treatment of earlobe keloids with surgery plus adjuvant intralesional verapamil and pressure earrings. Ann Plast Surg. 1996 Aug. 37(2):167-9. [QxMD MEDLINE Link].
Margaret Shanthi FX, Ernest K, Dhanraj P. Comparison of intralesional verapamil with intralesional triamcinolone in the treatment of hypertrophic scars and keloids. Indian J Dermatol Venereol Leprol. 2008 Jul-Aug. 74(4):343-8. [QxMD MEDLINE Link].
Ahuja RB, Chatterjee P. Comparative efficacy of intralesional verapamil hydrochloride and triamcinolone acetonide in hypertrophic scars and keloids. Burns. 2013 Oct 30. [QxMD MEDLINE Link].
Janssen de Limpens AM. The local treatment of hypertrophic scars and keloids with topical retinoic acid. Br J Dermatol. 1980 Sep. 103(3):319-23. [QxMD MEDLINE Link].
Panabiere-Castaings MH. Retinoic acid in the treatment of keloids. J Dermatol Surg Oncol. 1988 Nov. 14(11):1275-6. [QxMD MEDLINE Link].
Kwon SY, Park SD, Park K. Comparative effect of topical silicone gel and topical tretinoin cream for the prevention of hypertrophic scar and keloid formation and the improvement of scars. J Eur Acad Dermatol Venereol. 2014 Aug. 28(8):1025-33. [QxMD MEDLINE Link].
Berman B, Kaufman J. Pilot study of the effect of postoperative imiquimod 5% cream on the recurrence rate of excised keloids. J Am Acad Dermatol. 2002 Oct. 47(4 Suppl):S209-11. [QxMD MEDLINE Link].
Martin-Garcia RF, Busquets AC. Postsurgical use of imiquimod 5% cream in the prevention of earlobe keloid recurrences: results of an open-label, pilot study. Dermatol Surg. 2005 Nov. 31(11 Pt 1):1394-8. [QxMD MEDLINE Link].
Smith P, Mosiello G, Deluca L, Ko F, Maggi S, Robson MC. TGF-beta2 activates proliferative scar fibroblasts. J Surg Res. 1999 Apr. 82(2):319-23. [QxMD MEDLINE Link].
Prado A, Andrades P, Benitez S, Umana M. Scar management after breast surgery: preliminary results of a prospective, randomized, and double-blind clinical study with aldara cream 5% (imiquimod). Plast Reconstr Surg. 2005 Mar. 115(3):966-72. [QxMD MEDLINE Link].
Chuangsuwanich A, Gunjittisomram S. The efficacy of 5% imiquimod cream in the prevention of recurrence of excised keloids. J Med Assoc Thai. 2007 Jul. 90(7):1363-7. [QxMD MEDLINE Link].
Kim A, DiCarlo J, Cohen C, et al. Are keloids really "gli-loids"?: High-level expression of gli-1 oncogene in keloids. J Am Acad Dermatol. 2001 Nov. 45(5):707-11. [QxMD MEDLINE Link].
Berman B, Poochareon V, Villa AM. An open-label pilot study to evaluate the safety and tolerability of tacrolimus ointment 0.1% for the treatment of keloids. Cosm Dermatol. 2005. 18:399-404.
Ong CT, Khoo YT, Mukhopadhyay A, et al. mTOR as a potential therapeutic target for treatment of keloids and excessive scars. Exp Dermatol. 2007 May. 16(5):394-404. [QxMD MEDLINE Link].
Syed F, Sanganee HJ, Bahl A, Bayat A. Potent dual inhibitors of TORC1 and TORC2 complexes (KU-0063794 and KU-0068650) demonstrate in vitro and ex vivo anti-keloid scar activity. J Invest Dermatol. 2013 May. 133(5):1340-50. [QxMD MEDLINE Link]. [Full Text].
Hu D, Hughes MA, Cherry GW. Topical tamoxifen--a potential therapeutic regime in treating excessive dermal scarring?. Br J Plast Surg. 1998 Sep. 51(6):462-9. [QxMD MEDLINE Link].
Mikulec AA, Hanasono MM, Lum J, Kadleck JM, Kita M, Koch RJ. Effect of tamoxifen on transforming growth factor beta1 production by keloid and fetal fibroblasts. Arch Facial Plast Surg. 2001 Apr-Jun. 3(2):111-4. [QxMD MEDLINE Link].
Zhibo X, Miaobo Z. Botulinum toxin type A affects cell cycle distribution of fibroblasts derived from hypertrophic scar. J Plast Reconstr Aesthet Surg. 2008 Sep. 61(9):1128-9. [QxMD MEDLINE Link].
Zhibo X, Miaobo Z. Intralesional botulinum toxin type A injection as a new treatment measure for keloids. Plast Reconstr Surg. 2009 Nov. 124(5):275e-7e. [QxMD MEDLINE Link].
Xiao Z, Zhang F, Cui Z. Treatment of hypertrophic scars with intralesional botulinum toxin type A injections: a preliminary report. Aesthetic Plast Surg. 2009 May. 33(3):409-412. [QxMD MEDLINE Link].
Robinson AJ, Khadim MF, Khan K. Keloid scars and treatment with Botulinum Toxin Type A: the Belfast experience. J Plast Reconstr Aesthet Surg. 2013 Mar. 66(3):439-40. [QxMD MEDLINE Link].
Venus MR. Use of botulinum toxin type A to prevent widening of facial scars. Plast Reconstr Surg. 2007 Jan. 119(1):423-4; author reply 424. [QxMD MEDLINE Link].
Saulis AS, Mogford JH, Mustoe TA. Effect of Mederma on hypertrophic scarring in the rabbit ear model. Plast Reconstr Surg. 2002 Jul. 110(1):177-83; discussion 184-6. [QxMD MEDLINE Link].
McGrouther DA, et al. A Double Blind, Within Patient, Placebo Controlled Trial to Confirm the Efficacy of Juvista (Avotermin) in Conjunction With Scar Revision Surgery for the Improvement of Disfiguring Scars. ClinicalTrials.gov Identifier: NCT00742443. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00742443. Accessed: November 3, 2008.
Bush J, Duncan JA, Bond JS, et al. Scar-improving efficacy of avotermin administered into the wound margins of skin incisions as evaluated by a randomized, double-blind, placebo-controlled, phase II clinical trial. Plast Reconstr Surg. Nov/2010. 126(5):1604-15. [QxMD MEDLINE Link].
Bush J, et al. A Double Blind, Placebo Controlled Randomised Trial to Investigate the Scar Improvement Efficacy of a Single Intradermal Application of RN1001 (Avotermin) in Subjects Undergoing Excision of Benign Head and Neck Naevi. ClinicalTrials.gov Identifier: NCT00656227. ClinicalTrials.gov. Available at http://www.clinicaltrials.gov/ct2/show/NCT00656227. Accessed: November 3, 2008.
Bush J, et al. A Double-Blind, Placebo-Controlled, Randomised Dose Ranging Trial to Investigate the Efficacy of Two Different Dosing Regimens of Avotermin (Juvista) in the Improvement of Scar Appearance When Applied to Approximated Wound Margins in Healthy Volunteers. ClinicalTrials.gov Identifier: NCT00629811. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00629811. Accessed: November 3, 2008.
Gilbert P, et al. A Double Blind, Placebo Controlled, Randomised Trial to Investigate the Efficacy of Juvista (Avotermin) in the Improvement of Scar Appearance in Patients Undergoing Bilateral Reduction Mammaplasty. ClinicalTrials.gov Identifier: NCT00432328. ClinicalTrials.gov. Available at http://clinicaltrials.gov/ct2/show/NCT00432328. Accessed: November 3, 2008.
McCollum P, et al. A Dose Response Trial to Investigate the Efficacy of Juvista (Avotermin) in the Improvement of Scar Appearance When Applied to Approximated Wound Margins Following Bilateral Varicose Vein Removal. ClinicalTrials.gov Identifier: NCT00430326. ClinicalTrials.gov. Available at http://www.clinicaltrials.gov/ct2/show/NCT00430326. Accessed: November 3, 2008.
Young L. Trial of Juvista (Avotermin) following removal of ear lobe keloid scars. ClinicalTrials.gov. Available at https://clinicaltrials.gov/ct2/show/NCT00469235. Accessed: May 13, 2016.
Young V. Exploratory safety of the efficacy and safety of Juvista 250 ng when administered following excision of ear lobe keloids. ClinicalTrials.gov. Available at https://clinicaltrials.gov/ct2/show/NCT00836147. Accessed: May 13, 2016.
Young V. Safety of Juvista when administered following excision of ear lobe keloids (RN1001-0093). ClinicalTrials.gov. Available at https://clinicaltrials.gov/ct2/show/NCT00710333. Accessed: May 13, 2016.
Nanney LB. Epidermal and dermal effects of epidermal growth factor during wound repair. J Invest Dermatol. 1990 May. 94 (5):624-9. [QxMD MEDLINE Link].
Brown GL, Curtsinger L 3rd, Brightwell JR, Ackerman DM, Tobin GR, Polk HC Jr, et al. Enhancement of epidermal regeneration by biosynthetic epidermal growth factor. J Exp Med. 1986 May 1. 163 (5):1319-24. [QxMD MEDLINE Link].
Epstein JB, Gorsky M, Guglietta A, Le N, Sonis ST. The correlation between epidermal growth factor levels in saliva and the severity of oral mucositis during oropharyngeal radiation therapy. Cancer. 2000 Dec 1. 89 (11):2258-65. [QxMD MEDLINE Link].
Peled ZM, Rhee SJ, Hsu M, Chang J, Krummel TM, Longaker MT. The ontogeny of scarless healing II: EGF and PDGF-B gene expression in fetal rat skin and fibroblasts as a function of gestational age. Ann Plast Surg. 2001 Oct. 47 (4):417-24. [QxMD MEDLINE Link].
Kim YS, Lew DH, Tark KC, Rah DK, Hong JP. Effect of recombinant human epidermal growth factor against cutaneous scar formation in murine full-thickness wound healing. J Korean Med Sci. 2010 Apr. 25 (4):589-96. [QxMD MEDLINE Link].
Shin JU, Kang SW, Jeong JJ, Nam KH, Chung WY, Lee JH. Effect of recombinant human epidermal growth factor on cutaneous scar quality in thyroidectomy patients. J Dermatolog Treat. 2015 Apr. 26 (2):159-64. [QxMD MEDLINE Link].
Viera MH, Caperton CV, Berman B. Advances in the treatment of keloids. J Drugs Dermatol. 2011 May. 10 (5):468-80. [QxMD MEDLINE Link].
Berman B, Garikaparthi S, Smith E, Newburger J. A novel hydrogel scaffold for the prevention or reduction of the recurrence of keloid scars postsurgical excision. J Am Acad Dermatol. 2013 Nov. 69 (5):828-30. [QxMD MEDLINE Link].
Lee WJ, Song SY, Roh H, Ahn HM, Na Y, Kim J, et al. Profibrogenic effect of high-mobility group box protein-1 in human dermal fibroblasts and its excess in keloid tissues. Sci Rep. 2018 May 30. 8 (1):8434. [QxMD MEDLINE Link].
Zhao YX, Ho CK, Xie Y, Chen YH, Li HZ, Zhang GY, et al. Calcimycin Suppresses S100A4 Expression and Inhibits the Stimulatory Effect of Transforming Growth Factor β1 on Keloid Fibroblasts. Ann Plast Surg. 2018 May 24. [QxMD MEDLINE Link].
Zhang Y, Guo B, Hui Q, Li W, Chang P, Tao K. Downregulation of miR‑637 promotes proliferation and metastasis by targeting Smad3 in keloids. Mol Med Rep. 2018 May 29. [QxMD MEDLINE Link].
Gupta S, Kumar B. Intralesional cryosurgery using lumbar puncture and/or hypodermic needles for large, bulky, recalcitrant keloids. Int J Dermatol. 2001 May. 40(5):349-53. [QxMD MEDLINE Link].
Har-Shai Y, Sabo E, Rohde E, Hyams M, Assaf C, Zouboulis CC. Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies. Wound Repair Regen. 2006 Jan-Feb. 14(1):18-27. [QxMD MEDLINE Link].
Sclafani AP, Gordon L, Chadha M, Romo T 3rd. Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature. Dermatol Surg. 1996 Jun. 22(6):569-74. [QxMD MEDLINE Link].
Akita S, Akino K, Yakabe A, Imaizumi T, Tanaka K, Anraku K. Combined surgical excision and radiation therapy for keloid treatment. J Craniofac Surg. 2007 Sep. 18(5):1164-9. [QxMD MEDLINE Link].
Chaudhry MR, Akhtar S, Duvalsaint F, Garner L, Lucente FE. Ear lobe keloids, surgical excision followed by radiation therapy: a 10-year experience. Ear Nose Throat J. 1994 Oct. 73(10):779-81. [QxMD MEDLINE Link].
Berman B, Nestor MS, Gold MH, Goldberg DJ, Weiss ET, Raymond, et al. A retrospective registry study evaluating the long-term efficacy and safety of superficial radiation therapy following excision of keloid scars. J Clin Aesthetic Dermatol. Oct. 2020. In Press.
Berman B, Frankel S, Villa AM, Ramirez CC, Poochareon V, Nouri K. Double-blind, randomized, placebo-controlled, prospective study evaluating the tolerability and effectiveness of imiquimod applied to postsurgical excisions on scar cosmesis. Dermatol Surg. 2005 Nov. 31(11 Pt 1):1399-403. [QxMD MEDLINE Link].
Kim JH, Kim HJ, Kim YH, et al. The combination of copper bromide laser, a 10,600 nm ablative carbon dioxide laser and intralesional triamcinolone for the treatment of hypertrophic thyroidectomy scars. J Eur Acad Dermatol Venereol. Jan/2012. 26(1):125-6. [QxMD MEDLINE Link].
Wagner JA, Paasch U, Bodendorf MO, et al. Treatment of keloids and hypertrophic scars with the triple-mode Er:YAG laser: A pilot study. Med Laser Appl. 2011. 26:10–5.
Alster T. Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003 Jan. 29(1):25-9. [QxMD MEDLINE Link].
Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW. 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg. 2003 Jan. 29(1):65-73; discussion 73. [QxMD MEDLINE Link].
Wilgus TA, Bergdall VK, Tober KL, et al. The impact of cyclooxygenase-2 mediated inflammation on scarless fetal wound healing. Am J Pathol. 2004 Sep. 165(3):753-61. [QxMD MEDLINE Link]. [Full Text].
Conologue TD, Norwood C. Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal. Dermatol Surg. 2006 Jan. 32(1):13-20. [QxMD MEDLINE Link].
Manuskiatti W, Wanitphakdeedecha R, Fitzpatrick RE. Effect of pulse width of a 595-nm flashlamp-pumped pulsed dye laser on the treatment response of keloidal and hypertrophic sternotomy scars. Dermatol Surg. 2007 Feb. 33(2):152-61. [QxMD MEDLINE Link].
Bellew SG, Weiss MA, Weiss RA. Comparison of intense pulsed light to 595-nm long-pulsed pulsed dye laser for treatment of hypertrophic surgical scars: a pilot study. J Drugs Dermatol. 2005 Jul-Aug. 4(4):448-52. [QxMD MEDLINE Link].
Alam M, Pon K, Van Laborde S, Kaminer MS, Arndt KA, Dover JS. Clinical effect of a single pulsed dye laser treatment of fresh surgical scars: randomized controlled trial. Dermatol Surg. 2006 Jan. 32(1):21-5. [QxMD MEDLINE Link].
Apfelberg DB, Smith T, Lash H, White DN, Maser MR. Preliminary report on use of the neodymium-YAG laser in plastic surgery. Lasers Surg Med. 1987. 7(2):189-98. [QxMD MEDLINE Link].
Akaishi S, Koike S, Dohi T, Kobe K, Hyakusoku H, Ogawa R. Nd:YAG Laser Treatment of Keloids and Hypertrophic Scars. Eplasty. 2012. 12:e1. [QxMD MEDLINE Link].
Mamalis AD, Lev-Tov H, Nguyen DH, Jagdeo JR. Laser and light-based treatment of Keloids--a review. J Eur Acad Dermatol Venereol. 2014 Jun. 28(6):689-99. [QxMD MEDLINE Link].
Chiu LL, Sun CH, Yeh AT, et al. Photodynamic therapy on keloid fibroblasts in tissue-engineered keratinocyte-fibroblast co-culture. Lasers Surg Med. 2005 Sep. 37(3):231-44. [QxMD MEDLINE Link].
Ud-Din S, Thomas G, Morris J, Bayat A. Photodynamic therapy: an innovative approach to the treatment of keloid disease evaluated using subjective and objective non-invasive tools. Arch Dermatol Res. 2013 Apr. 305(3):205-14. [QxMD MEDLINE Link].
Asawanonda P, Khoo LS, Fitzpatrick TB, Taylor CR. UV-A1 for keloid. Arch Dermatol. 1999 Mar. 135(3):348-9. [QxMD MEDLINE Link].
Sasaki T, Holeyfield KC, Uitto J. Doxorubicin-induced inhibition of prolyl hydroxylation during collagen biosynthesis in human skin fibroblast cultures. Relevance to imparied wound healing. J Clin Invest. 1987 Dec. 80(6):1735-41. [QxMD MEDLINE Link]. [Full Text].
Kang S, et al. The Effectiveness Of UVA1 Irradiation In The Treatment Of Skin Conditions With Altered Dermal Matrix: A Controlled, Cross-Over Study. ClinicalTrials.gov Identifier: NCT00476801. ClinicalTrials.gov. Available at http://www.clinicaltrials.gov/ct2/show/NCT00476801. Accessed: November 1, 2008.
Kang S, et al. The Effectiveness of UVA1 Irradiation in the Treatment of Skin Conditions With Altered Dermal Matrix: An Open Pilot Study. ClinicalTrials.gov Identifier: NCT00476697. ClinicalTrials.gov. Available at http://www.clinicaltrials.gov/ct2/show/NCT00476697. Accessed: November 1, 2008.
Choi CP, Kim YI, Lee JW, Lee MH. The effect of narrowband ultraviolet B on the expression of matrix metalloproteinase-1, transforming growth factor-beta1 and type I collagen in human skin fibroblasts. Clin Exp Dermatol. 2007 Mar. 32(2):180-5. [QxMD MEDLINE Link].
Oiso N, Kawara S, Kawada A. The effectiveness of narrowband ultraviolet B on hypertrophic scar in a patient having an isomorphic phenomenon and vitiligo. J Eur Acad Dermatol Venereol. 2008 Aug. 22(8):1003-4. [QxMD MEDLINE Link].
Varga J, Diaz-Perez A, Rosenbloom J, Jimenez SA. PGE2 causes a coordinate decrease in the steady state levels of fibronectin and types I and III procollagen mRNAs in normal human dermal fibroblasts. Biochem Biophys Res Commun. 1987 Sep 30. 147(3):1282-8. [QxMD MEDLINE Link].
Wirohadidjojo YW, Radiono S, Budiyanto A, et al. Cellular viability, collagen deposition, and transforming growth factor beta-1 production among ultraviolet B-irradiated keloid fibroblasts. Aesthetic Plast Surg. Dec/2011. 35(6):1050-5. [QxMD MEDLINE Link].
Cartier H. Use of intense pulsed light in the treatment of scars. J Cosmet Dermatol. 2005 Jan. 4(1):34-40. [QxMD MEDLINE Link].
Erol OO, Gurlek A, Agaoglu G, Topcuoglu E, Oz H. Treatment of hypertrophic scars and keloids using intense pulsed light (IPL). Aesthetic Plast Surg. 2008 Nov. 32(6):902-9. [QxMD MEDLINE Link].
Berman B, Viera MH, Amini S, Huo R, Jones IS. Prevention and management of hypertrophic scars and keloids after burns in children. J Craniofac Surg. 2008 Jul. 19(4):989-1006. [QxMD MEDLINE Link].

Media Gallery

Clawlike outline of a keloid. Courtesy of Dirk M. Elston, MD.
Keloid. Courtesy of Dirk M. Elston, MD.
Keloid. Courtesy of Dirk M. Elston, MD.
Keloid. Courtesy of Dirk M. Elston, MD.
Histology of keloid demonstrating central zone of hyalinized collagen (hematoxylin and eosin stain). Courtesy of Dirk M. Elston, MD.
Histology of keloid demonstrating thick hyalinized collagen bundles (hematoxylin and eosin stain). Courtesy of Dirk M. Elston, MD.

of 6

Author

Brian Berman, MD, PhD Dermatologist and Partner, Skin and Cancer Associates; Professor Emeritus of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine

Brian Berman, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Aclaris; Bifrontera; Aiviva; Pulse; Celumigen; Dermira; DUSA Sun; Exeltis, Ferndale; Galderma; GSK; Halscion; Klara; Leo; Medimetriks; Miragen; Novan;Novartis;TopMD; Aclaris; Menlo;Cara;Lemonex;Mediwound;Almirall;Pfizer;Sirnaomics;Minolab;BPGBio;Thirona<br/>Serve(d) as a speaker or a member of a speakers bureau for: Sun; Exeltis, Ferndale; Galderma; GSK; Halscion; Leo Pharmaceuticals; Medimetriks; Miragen; Novan; Novartis; Valeant Pharmaceuticals; Anacor; Clark; Aclaris; Sensus;Almirall<br/>Received research grant from: Dermira; DUSA; Exeltis, Ferndale; Galderma; Leo; Menlo; Anacor; Clark; Pulse; Miragen; Sensus; Minolab<br/>Received income in an amount equal to or greater than $250 from: Bifrontera; Aiviva; Pulse Biosciences; Dermira; DUSA; Sun; Menlo; Exeltis, Ferndale; Galderma; GSK; Halscion; Leo; Medimetriks; Miragen; Novan; Novartis; TopMD; Anacor;Aclaris; Sensus; Cara; Lemonex; Mediwound;Almirall;Minolab;Thirona;BPGBio.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Sadegh Amini, MD Dermatologist, Skin Cancer Associates; Voluntary Assistant Professor, Department of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine.

Sadegh Amini, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, International Society for Dermatologic Surgery, International Society of Dermatology

Disclosure: Own stocks at NYSE for: AbbVie Inc.

Martha H Viera, MD Resident Physician, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine

Martha H Viera, MD is a member of the following medical societies: American Medical Association, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

Andrea D Maderal, MD Resident Physician, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine

Andrea D Maderal, MD is a member of the following medical societies: American Academy of Dermatology, Florida Society of Dermatology and Dermatologic Surgery, Medical Dermatology Society, Miami Society for Dermatology, Rheumatologic Dermatology Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Whitney Valins, MD, to the development and writing of the source articles.

Keloid and Hypertrophic Scar Workup

Laboratory Studies

Other Tests

Histologic Findings

References

Tables

Contributor Information and Disclosures

What would you like to print?