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2.
Phases of Healing

3.
Phases of Healing
• Inflammatory (Reactive)
Haemostasis Inflammation
• Proliferative (Regenerative/Reparative)
Epithelial migration proliferation Maturation
• Maturational (Remodeling)
Contraction scarring Remodeling

4.
Excessive Scar Formation

5.
Excessive Scar Formation
• Dense extracellular matrix consisting of collagen
and glycosaminoglycans.

6.
Definition

7.
Definition
• The keloid is defined as an abnormal scar
that grows beyond the boundaries of the
original site of skin injury.
• The hypertrophic scar is defined as a
widened or unsightly scar that does not
extend beyond the original boundaries of
the wound.
• Unlike keloids, the hypertrophic scar
reaches a certain size and subsequently
stabilizes or regresses.

8.
Epidemiology

9.
Epidemiology
• Keloids are seen with greater frequency in
blacks, Hispanics, and Asians.

10.
Sites

11.
Sites
• the sternum, deltoid region of the upper
arm, and upper back,
• earlobes, mandibular border, and posterior
neck.
• Trauma

12.
Etiology and Pathophysiology

13.
Etiology and Pathophysiology
• Not known.
• Numerous Theories-
– allergic immunoglobulin E (IgE)–mediated
response,
– deficiency in melanocyte-stimulating hormone
(MSH) metabolism or an excess of MSH .
– microvascular occlusion and subsequent
hypoxia

14.
Etiology and Pathophysiology
– interleukin-6 (IL-6) expression in the
pathophysiology of keloids, and the role of
insulinlike growth factor-1 (IGF-1) and IGF-1
receptor axis in the invasive activity of keloids.
– ecause keloids are more prevalent in certain
families and populations, genetic factors most
likely impact keloid formation.
Recently, DeltaNp63 overexpression
and p53 underexpression have been identified
in fibroblasts from keloids.[3]

15.
Treatment & Management

16.
Treatment & Management
• surgical,
• nonsurgical, and
• ombined modality treatment.

17.
Treatment :Surgical

18.
Treatment :Surgical
• simple excision, providing wound closure
without undue tension. .

19.
Treatment :Nonsurgical

20.
Treatment :Nonsurgical
• Pressure garments
• injection of intralesional triamcinolone
• Lasers, such as carbon dioxide, pulse dye,
neodymium-yttrium aluminum garnet (Nd-
YAG), and argon,
• Various therapies, including nitrogen
mustard, tetroquinone, antihistamines,
retinoic acids, zinc, vitamin A, vitamin E,
and verapamil
• Interferon

21.
Treatment :Combined modality

22.
Treatment :Combined modality
• laser-assisted skin healing (LASH). After
excess hypertrophic scar tissue was
removed, the authors applied laser
irradiation followed with topical silicone gel
sheeting for 2 months. Six months after
revision, no recurrence of hypertrophic
scarring was noted
• cold-knife excision followed by
postoperative injection of intralesional
steroid.

23.
Treatment :Combined modality
•

24.
Treatment :Combined modality
• Cryosurgery
• surgical excision and external beam
radiotherapy

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