Keloid and Hypertrophic Scar Workup

Updated: Jun 12, 2018
  • Author: Brian Berman, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Workup

Laboratory Studies

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

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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.

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