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aberrant scarring, collagen, elastin, fibrillin 1, hypertrophic scars, keloids, TGF-[beta]



  1. Ghazawi, Feras M. MD, PhD, MSc
  2. Zargham, Ramin MD, PhD
  3. Gilardino, Mirko S. MD, MSc
  4. Sasseville, Denis MD
  5. Jafarian, Fatemeh MD


GENERAL PURPOSE: To provide information about the clinical presentation of hypertrophic scars and keloids based on their varied structural components.


TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.


LEARNING OBJECTIVES/OUTCOMES: After completing this continuing education activity, you should be able to:


1. Distinguish between the clinical presentations of hypertrophic scars and keloids.


2. Identify their underlying mechanisms of scarring and the treatments available.



ABSTRACT: Hypertrophic scars and keloids are firm, raised, erythematous plaques or nodules that manifest when the cicatrix fails to properly heal. They result from pathologic wound healing and often cause pain and decreased quality of life. The appearance of such cosmetically unappealing scars affects the confidence and self-esteem of many patients. These scars can also cause dysfunction by interfering with flexion and extension across joints. Both possess some unique and distinct histochemical and physiologic characteristics that set them apart morphologically and at the molecular level. While these entities have been the focus of research for many years, differentiating between them remains challenging for clinicians.


This article reviews the clinical presentation of aberrant scars and illustrates how they can be differentiated. It outlines their pathophysiology and emphasizes the unique molecular mechanisms underlying each disorder. It also examines how altered expression levels and the distribution of several factors may contribute to their unique clinical characteristics and presentation. Further research is needed to elucidate optimal treatments and preventive measures for these types of aberrant scarring.