How Wounds can be Classified?
Widespread Scars, Stretch Marks, Oversized Scars, Atrophic Scars, Scar Contractures, Keloids

Keloids Types

Summary: There are several causes for scarring, and specific alterations will determine the result of the scarring.

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The spectrum of skin keloid types

Skin tissues repair results in a wide spectrum of scars, ranging from a "normal" fine line to a variety of abnormal scarring, including widespread scars, atrophic scars, scar contractures, hypertrophic scars, and keloid scars.

Widespread (stretched) scars can be seen when the fine lines of surgical scars gradually become stretched and widened, which use to happen in the three weeks after surgical intervention. They are typically flat, pale, soft scars often seen after knee or shoulder surgery. Stretch marks (abdominal striae) after pregnancy are another type of widespread scars in which there has been damage to the dermis and subcutaneous tissues but the epidermis is unbreached. There is no rise, thickening, or nodularity in mature wide-spread scars, which makes them different from hypertrophic scars.

Atrophic scars are flat and depressed below the surrounding healthyskin. They are usually small and often round with an indented or inverted centre, and often appear after acne or smallpox.

Scar contractures -scars across joints or skin creases at right angles have a tendency to develop shortening or contracture. Scar contractures are developed when the scar is not completely matured, usually tend to be hypertrophic, and are often disabling and dysfunctional (fig 4). They appear after burn damage across joints or skin concavities.

Raised skin scars

Raised skin scars are also known as hypertrophic or keloid scars.

Hypertrophic scars are raised scars that remain within the boundaries of the original lesion, usually regressing by itself after the initial lesion. Hypertrophic scars are often red, inflamed, itchy, and even painful. They typically occur after burn injury on the trunk and extremities.

Keloid scars are raised scars that spread beyond the margins of the original lesion

Keloids scars are thick, puckered, itchy clusters of scars spreading beyond the edges of the wound or surgicalincision and invade the surrounding normal skin in a way that is site specific. They are often red or darker than the surrounding skin. Keloids appear when the body continues to produce collagen long after the original wound healing has taken place.

Ear lobe keloids often grow as large lobules, central sternal keloids commonly develop a butterfly shape, and deltoid keloids tend to grow vertically. A keloid continues to grow over time, does not regress by itself, and almost always reappears after simple excision. It's hard to apply the term keloid until a scar has been present for at least a year, but there is no a fixed time interval. Histologically, keloids have a swirling nodular pattern of collagen fibres.

Scars that are difficult to categorise have been termed intermediate scars. However, if a raised scar is still emerging after a year, a true keloid is a possible diagnosis, whereas hypertrophic scars should show some signs of regression within this time. Keloids can be inflamed, itchy, and painful, especially during their growth phase. Common presentations are in the ear lobe after ear piercing, the deltoid after vaccination, and the sternum after acne, chickenpox, trauma, or surgery. Keloids are unique to humans, and there may be some genetic predisposition, with dark skinned races being more vulnerable to them, though there are few serious epidemiological studies. They develop predominantly in people aged 10 - 30 years, with an apparent raised prevalence for emergence and deterioration during puberty and pregnancy.

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There's not a single, predictable process of scarring. Is there a powerful enough Scar Treatment to deal with this?

Recent Research about How Wounds can be Classified?

Main causes of facial wounds

Wulkan M, Parreira JG Jr, Botter DA.
Pronto-Socorro Central da Irmandade, Santa Casa de Misericordia de Sao Paulo, SP.

OBJECTIVES: This document aims to determine the incidence, etiology, severity of facial trauma and similar injuries to achieve a better understanding of its range and magnitude.

METHODS: A hundred and sixty four patients were selected with some degree of facial trauma regardless of gender, age and skin color. Data were analyzed by the Pearson chi2 statistical method.

RESULTS: A male predominance was observed (78%) and its peak age was between 20 and 39 years. The major cause was interpersonal violence (48.1%), followed by fall (26.2%), run overs 6.4%), sports (5.4%), car accidents (4.2%), motorcycle accidents (3.1%), non-fall impacts (2.4%), occupational injuries (1.8%), gunshot wounds (1.2%), unspecific (1.2%). Contusion is the most common injury (23.8%), followed by fractures of the mandible (21.9%), Le Fort/pan facial/complex (17.8%), nasal bones (11.6%), zygoma (10.3%), tooth (9.1%), orbit (4.9%) and maxilla (0.6%). Associated injuries occurred mostly in run overs, but also because of car accident, fall and interpersonal violence.

CONCLUSIONS: The causes of facial trauma are directly related to the age and type of lesion. No evidence was found that the causes were related to gender or severity of the lesion.