Hypertrophic Scars vs. Keloids: Key Differences Explained - Dermatology

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Understanding the differences between hypertrophic scars and keloids is essential for anyone considering cosmetic procedures like tattoos, especially if they have a history of scarring. Both hypertrophic scars and keloids are types of abnormal scar tissue that can form after an injury, but they have distinct characteristics and behaviors.

Hypertrophic Scars are raised scars that develop due to an overproduction of collagen during the healing process. They typically remain within the boundaries of the original wound and may become less prominent over time. Hypertrophic scars can be red, itchy, and sometimes painful, but they usually do not grow larger than the original injury. Importantly, they often flatten and fade with time, which seems to align with your observation that your scars have become flatter over the years.

Keloids, on the other hand, are more aggressive forms of scarring. They extend beyond the original wound site and can continue to grow over time, sometimes becoming quite large and raised. Keloids can be itchy, painful, and may cause discomfort. Unlike hypertrophic scars, keloids do not typically regress or flatten over time; they can persist indefinitely and may require medical intervention for treatment.

In your case, since you mentioned that the scars have not changed in size over the past ten years and have even become flatter, it is more likely that you are dealing with hypertrophic scars rather than keloids. The fact that they are not painful or itchy is also a positive sign. However, the risk of developing a keloid can vary based on individual factors, including genetics, skin type, and the location of the scar.

When considering getting a tattoo over these scars, it is crucial to consult with a dermatologist or a qualified medical professional. They can assess the scars' characteristics and provide personalized advice. If the scars are hypertrophic, the likelihood of them becoming keloid-like after tattooing is lower, but there is still a risk. Tattooing can sometimes trigger an inflammatory response in the skin, which could potentially lead to the formation of a keloid, especially if you have a predisposition to keloid formation.

Additionally, if you have a history of keloids or hypertrophic scars, it may be advisable to proceed with caution. Some professionals recommend doing a patch test on a small area of the scar to see how your skin reacts before committing to a larger tattoo. This approach can help mitigate the risk of unexpected scarring.

In summary, while hypertrophic scars and keloids are both raised scars, they differ significantly in their behavior and treatment. Given your description, it seems more likely that you have hypertrophic scars, especially since they have not changed significantly over time. However, consulting with a medical professional is essential to ensure that you make an informed decision regarding your tattoo plans. They can provide guidance tailored to your specific situation and help you understand the potential risks involved.