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Scars are an unfortunate fact of life. Their main purpose is to reconnect skin that has been injured. At first, they may be red or dark and rose after the injury has been cured but will become paler and flatter naturally over time, resulting in a flat, pale scar.

For reasons that are still not fully understood, some people develop raised scars that are red and thick and may be itchy or painful. Others form scars that grow beyond the site of an injury, called keloid scars.

Keloid scars are basically engrossed, itchy, puckered scars that grow beyond the limits of an injury or incision and rarely regress. They appear when the body keeps producing tough, fibrous protein (called collagen) after an injury has healed.

Keloid scars can result from any kind of injury to the skin, including bruises, tattoos, insect bites, injections or medical procedures, etc. Keloid scars can show anywhere on the body, but most commonly appear over the breastbone, on earlobes and on shoulders.

Keloids are fibrous tumors characterized by a mass of atypical fibroblasts with high deposition of extracellular matrix components, especially collagen, fibronectin, elastin, and proteoglycans. Histologically, keloids contain mostly acellular centers and engrossed, abundant collagen accumulations that create nodules in the deep skin section of the lesion. Keloids present a clinical problem that must be attended as these lesions can produce great pain, pruritus (itch) and physical disfigurement, may not improve in appearance over time, and can even restrict mobility if formed over a joint.

Unlike keloids, hypertropic scars are confined to the wounded site and usally flatten out over time. Hypertrophic scars can be difficult to differentiate from keloid scarring microscopically and biochemically because both kinds produce larger quantities of collagen than normal scars. Both can be caused|the result of surgery, accidents and even acne.

Hypertrophic scars, however, will often exhibit declining collagen production after about six months. Hypertrophic scars contain about twice as much glycosaminoglycans as normal scars, and this and increased synthetic and enzymatic reactions result in significant changes in the matrix which alters the mechanical capabilities of the scars, including minor extensibility that makes them feel firm.

As with hypertrophic scars, people having one keloid scar are likely to be prone to this scars in the future and must speak with their doctor or specialist if they are likely to need injections or to have any kind of surgery.

Atrophic scars are characterized by a thinning and reduced elasticity of the skin due to a loss of normal skin architecture. An example of an atrophic scar is striae distensae, also called stretch marks. This type of scar can also be produced by acne lesions.