• Definition: skin lesions caused by high fibroblast proliferation and collagen production as excessive tissue response to, typically small, skin injuries
• Etiology: imbalance in wound healing processes due to local factors and genetics
• Pathophysiology
  • Increased synthesis and unorganized deposition of collagen type I and collagen type III
  • Increased TGF-β expression and fibroblast proliferation
• Clinical features
  • Brownish-red scar tissue of varying consistency (soft or hard) with claw-like appearance that grows beyond the boundaries of the original lesion
  • Pruritus
  • Pain
  • Localization: earlobes, face (especially cheeks), upper extremities, chest, and neck
• Diagnosis: based on clinical appearance of lesion and patient history of trauma or surgery
• Treatment: same as for hypertrophic scars (see above)
  • Keloid scars recur after surgical excision in up to 100% of cases. A combined approach to treatment may have more success than surgery alone.
• Prognosis
  • Does not regress spontaneously
  • Frequent recurrences after resection