Keloids and Hypertrophic Scars: Characteristic Vascular Structures Visualized by Using Dermoscopy

Abstract

BackgroundKeloids and hypertrophic scars represent excessive scarring. They require different therapeutic approaches, which can be hampered because of an apparent lack of morphologic difference between the two diseases.ObjectiveThis study investigated the clinical and dermoscopic features of keloids and hypertrophic scars in order to help dermatologists distinguish these lesions better.MethodsA total of 41 keloids and hypertrophic scars in 41 patients were examined clinically and by performing dermoscopy with a digital imaging system. Lesions were evaluated for vascular structures.ResultsDermoscopy revealed vascular structures in most keloid lesions (90%) but in only 27% of hypertrophic scar lesions. The most common dermoscopic vascular structures in keloids were arborizing (52%), followed by linear irregular (33%) and commashaped (15%); these features were present but less evident in hypertrophic scars (9% for all types). The distribution frequency of the vascular structures differed significantly between diseases (p<0.001).ConclusionA strong association of vascular structures with keloids was observed on dermoscopic examination. The results suggest dermoscopic examination of vascular structures is a clinically useful diagnostic tool for differentiating between keloids and hypertrophic scars.

A validation study of scar vascularity and pigmentation assessment using dermoscopy

“…These instruments are either expensive (according to our investigation, the dermoscope we used in this study only costed around 10% to 25% of the prices of the other instruments), or not portable and difficult to use. Dermoscopy has been used by dermatologists for years in diagnosing dermatologic diseases, and recently reported being used to differentiate vascular structures between keloids and hypertrophic scars [20], but has never been used to quantitatively assess the hypertrophic scars. With this instrument, the clinician is able to observe structures at the epidermal and superficial dermal layers of the hypertrophic scar.…”

Stimulated infrared thermography applied to differentiate scar tissue from peri-scar tissue: a preliminary study

“…During tissue repair there is a change of the amount and nature of collagen production, capillaries, hair follicles and glands, which results in a scar with a different colour from the original tissue and with a loss of elasticity. [6][7][8][9] Regarding scar tissues, the local vasculature is altered while the healing process is occurring, with the formation of new vessels. [10][11][12] Indeed, the developing new granulation tissue undergoes angiogenesis.…”

The Characteristics of Blood Supply and Tissue Hypoxia in Pathological Scars

“…8 One of the causes of vascular occlusion is the excessive proliferation of endothelial cells. 6 Under an electron microscope, marked bulging of the endothelial lining into vascular lumens was visible in keloids. 9 The second cause is the intense proliferation of fibroblasts.…”

“…In terms of spatial vascular structure, blood vessels within hypertrophic scar tissues have a structure perpendicular to the skin surface, whereas those within keloid tissues present a typical dispersed, extended vascular structure. 5,6 The diameter or patency of the blood vessels of pathological scar remains controversial. Thaís et al used stereological methods to obtain information on pathological scar tissues with a microscope, and proposed that the blood vessels within the pathological scars were dilated compared with those in normal skin and normal scars.…”