Which of the following statement(s) is/are true concerning excessive scarring processes?
A. Keloids occur randomly regardless of gender or race B. Hypertrophic scars and keloid are histologically different C. Keloids tend to develop early and hypertrophic scars late after the surgical injury D. Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention
Simple reexcision and closure of a hypertrophic scar can be useful in certain situations such as a wound closed by secondary intention-true keloids are uncommon and occur predominantly in dark skinned people with a genetic predisposition for keloid formation. in most cases, the gene appears to be transmitted as an autosomal dominant pattern. the primary difference between a keloid and a hypertrophic scar is that a keloid extends beyond the boundary of the original tissue injury. it behaves as a tumor and extends into or invades the normal surrounding tissue creating a scar that is larger than the original wound. histologically, keloids and hypertrophic scars are similar. both contain an overabundance of collagen. although the absolute number of fibroblasts is not increased, the production of collagen continually out paces the activity of collagenase, resulting in a scar of ever increasing dimensions. hypertrophic scars respect the boundaries of the original injury and do not extend into normal unwounded tissue. there is less of a genetic predisposition, but hypertrophic scars also occur more frequently in orientals and the black population. they are often seen on the upper torso and across flexor surfaces. some improvement in a keloid can be obtained with excision followed by intra-lesional steroid injection. however, the resulting scar is unpredictable and potentially worse. reexcision and closure should, however, be considered for hypertrophic scars, if the condition of closure can be improved. this is especially pertinent for wounds that originally healed by secondary intention or that are complicated by infection. keloids typically develop several months after the injury and rarely, if ever, subside. hypertrophic scars usually develop within the first month after wounding and often subside gradually.