• Scar formation can be a normal part of the healing process
• In some cases scar tissue formation can be excessive
• The two types of excessive scar tissue formation are known as keloid and hypertrophic scarring
• Keloid scarring tends to overgrow the boundary of the initial injury, and can be painful and/or itchy. Keloids usually don't get better with time. Surgical revision of keloid scars can make them worse
• Hypertrophic scarring tends to remain within the boundary of the initial injury, and get better with time.
• Darker skin types predispose to keloid scar formation
• Keloid scars be be treated with a combination of laser, cortisone/5FU injections
• Hypertrophic scars can also be treated with laser, cortisone/5FU injections and also surgical revision.

Scar formation can be a normal part of the tissue healing process. In some cases, scar formation can be excessive beyond what is necessary to heal a wound. Keloid and hypertrophic scars result from an abnormal wound healing response in particular individuals. They are the body's response to trauma, inflammation, surgery or burns, and sometimes can occur spontaneously. Common skin injuries that lead to keloid growth are; surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites, burns, acne, chicken pox, folliculitis/ingrown hairs, and shingles. Their appearance is of a raised, often red/purple coloured scar that can have a firm consistency.

The difference between keloid and hypertrophic scars is difficult to determine at times. Keloid scars tend to extend from the boundary of the original wound and do not regress, whereas hypertrophic scars tend to not extend from the original would and regress over time.

Table: Differences between keloid and hypertrophic scarring

Sometimes, however, fibroblasts decide to work some crazy overtime. Fibroblasts keep producing collagen to keep covering over the wound. With your collagen now working extra, your initial scar can seem to take on a life of its own. It can become raised, red, bulky and angry-looking.

A really big, piled-up scar is called a keloid. It is the result of your fibroblasts and collagen not knowing when to quit. A keloid is a raised, reddish, and rubbery nodule that keeps growing on top of the healed wound. A keloid can get as big as a baseball. In this case you'll probably want to refrain from telling your friends, "Let me show you my scar."

A hypertrophic scar is like a keloid, but much smaller. The hypertrophic scar forms on top of the initial wound but has the courtesy to stay within the wound boundary. Hypertrophic scars usually fade with time.

About 10 percent of the population gets keloids. Some areas of the body have a predisposition to keloids: the ears, outer arms, back and upper chest. All races develop keloids, though dark-skinned people seem predisposed to developing scars that enlarge with a raised appearance (keloids).

If you are under the care of a plastic surgeon and your scarring is the result of cosmetic or plastic surgery, ask your surgeon for his or her recommendation if over-the-counter treatment is sufficient; otherwise, he or she will prescribe that which best suits your personal case.