title: Keloids and Hypertrophic Scars: Pathophysiology, Classification, and Treatment.
abstract: BACKGROUND
  Keloid and hypertrophic scars represent an aberrant response to the wound healing process. These scars are characterized by dysregulated growth with excessive collagen formation, and can be cosmetically and functionally disruptive to patients.
  
  
  OBJECTIVE
  Objectives are to describe the pathophysiology of keloid and hypertrophic scar, and to compare differences with the normal wound healing process. The classification of keloids and hypertrophic scars are then discussed. Finally, various treatment options including prevention, conventional therapies, surgical therapies, and adjuvant therapies are described in detail.
  
  
  METHODS
  Literature review was performed identifying relevant publications pertaining to the pathophysiology, classification, and treatment of keloid and hypertrophic scars.
  
  
  RESULTS
  Though the pathophysiology of keloid and hypertrophic scars is not completely known, various cytokines have been implicated, including interleukin (IL)-6, IL-8, and IL-10, as well as various growth factors including transforming growth factor-beta and platelet-derived growth factor. Numerous treatments have been studied for keloid and hypertrophic scars,which include conventional therapies such as occlusive dressings, compression therapy, and steroids; surgical therapies such as excision and cryosurgery; and adjuvant and emerging therapies including radiation therapy, interferon, 5-fluorouracil, imiquimod, tacrolimus, sirolimus, bleomycin, doxorubicin, transforming growth factor-beta, epidermal growth factor, verapamil, retinoic acid, tamoxifen, botulinum toxin A, onion extract, silicone-based camouflage, hydrogel scaffold, and skin tension offloading device.
  
  
  CONCLUSIONS
  Keloid and hypertrophic scars remain a challenging condition, with potential cosmetic and functional consequences to patients. Several therapies exist which function through different mechanisms. Better understanding into the pathogenesis will allow for development of newer and more targeted therapies in the future.
authors.affiliation: *Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida; †Dermatology Resident, University of Miami Miller School of Medicine, Miami, Florida; ‡Micrographic Surgery and Dermatologic Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts.
authors.forename: Brian
authors.initials: B
authors.lastname: Berman
authors.forename: Andrea
authors.initials: A
authors.lastname: Maderal
authors.forename: Brian
authors.initials: B
authors.lastname: Raphael
mesh_terms: D000465:Algorithms; D002921:Cicatrix / Q000503:physiopathology; D017439:Cicatrix, Hypertrophic / Q000145:classification / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007627:Keloid / Q000145:classification / Q000503:physiopathology* / Q000628:therapy; D014945:Wound Healing / Q000502:physiology*