Clinical Features Distinguishing Hypertrophic Scars and Keloids

While a keloid and a hypertrophic scar may show look similar, clinical features can help distinguish between the two processes.

Parameter	Keloidal Scar	Hypertrophic Scar
usual locations	earlobes, shoulders, presternal skin, upper back	abdomen
occurrence at joints	rare	common
unusual sites	eyelids, genitalia, palms, soles
relationship to motion and skin tension	independent	correlate with (occur in lesions crossing skin creases at right angles)
boundary	overgrows wound boundaries	limited extent
onset after inciting trauma	may be delayed for weeks or months	often develops shortly after injury
onset without inciting injury (spontaneous)	may occur	rare
size relative to inciting injury	lesion out of proportion to injury	size commensurate with injury
regression over time	rare	usual
outcome after surgery	often worsened	usually improved with appropriate surgery

Other distinguishing features:

(1) history of previous keloids

(2) appearance with MRI (Babu et al)

To read more or access our algorithms and calculators, please log in or register.