Which feature best distinguishes a hypertrophic scar from a keloid in wound healing?

Question

Accepted Answer

D. Hypertrophic scars remain confined within the original wound boundaries, while keloids extend beyond them. ## Distinguishing Hypertrophic Scars from Keloids

### Clinical Boundary Definition

**Key Point:** The most reliable discriminator between hypertrophic scars and keloids is the spatial relationship to the original wound boundary.

| Feature | Hypertrophic Scar | Keloid |
|---------|-------------------|--------|
| **Boundary** | Confined within original wound margins | Extends beyond original wound boundaries |
| **Onset** | Appears within weeks to months | May appear months to years after injury |
| **Regression** | Often regresses spontaneously over 1–2 years | Rarely regresses; persists indefinitely |
| **Genetics** | Less ethnically predisposed | Increased in darker skin types (African, Asian) |
| **Symptoms** | May be pruritic or tender | Often pruritic, painful, or symptomatic |
| **Histology** | Organized collagen bundles parallel to skin surface | Haphazard, whorled collagen; extends into dermis |
| **Treatment Response** | Moderate response to steroids and pressure | Variable; often resistant to conservative therapy |

### Pathophysiologic Basis

**High-Yield:** Hypertrophic scars represent an exaggerated but self-limited fibroproliferative response that respects anatomic boundaries. Keloids reflect a pathologic, autonomous fibroblast proliferation that breaches the original wound margin—a hallmark of abnormal wound healing.

### Clinical Pearl

A simple bedside rule: if the raised scar tissue stays *within* the scar line, it is hypertrophic; if it *spills over* into normal skin, it is a keloid. This distinction is crucial because keloids are much more difficult to treat and have a higher recurrence rate after excision (45–50%).

### Mnemonic

**HYPER = Hypertrophic = Hemmed in (within boundaries)**

**KELO = Keloid = Knows no limits (extends beyond)**

Answer

A. Hypertrophic scars respond poorly to intralesional corticosteroids, while keloids respond excellently

Answer

B. Hypertrophic scars are painless, while keloids are always pruritic and painful

Answer

C. Hypertrophic scars appear immediately after wound closure, while keloids develop only after 6 months

Which feature best distinguishes a hypertrophic scar from a keloid in wound healing?

Explanation

Distinguishing Hypertrophic Scars from Keloids

Clinical Boundary Definition

Pathophysiologic Basis

Clinical Pearl

Mnemonic

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Feature	Hypertrophic Scar	Keloid
Boundary	Confined within original wound margins	Extends beyond original wound boundaries
Onset	Appears within weeks to months	May appear months to years after injury
Regression	Often regresses spontaneously over 1–2 years	Rarely regresses; persists indefinitely
Genetics	Less ethnically predisposed	Increased in darker skin types (African, Asian)
Symptoms	May be pruritic or tender	Often pruritic, painful, or symptomatic
Histology	Organized collagen bundles parallel to skin surface	Haphazard, whorled collagen; extends into dermis
Treatment Response	Moderate response to steroids and pressure	Variable; often resistant to conservative therapy