When your wound starts to heal the body produces more collagen which gathers around the damaged tissue and seals it. However, in keloid scars the collagen production doesn’t stop and the scar extends beyond the borders of the original wound in the form of dense fibrous tissue.

Keloid scars are raised and range in consistency from soft and doughy to hard and rubbery. They can appear anywhere on the body although they usually form in the area of shoulders, cheeks, earlobes and neck area. Burn scars or infected lesions, including acne, are more likely to form keloids. Keloid scars sometimes itch and may be painful. Keloid scars are 15 times more likely to occur in darker-skinned individuals, may be familial, and tend to develop more readily during and after puberty.

While keloid scars are difficult to treat, combination treatments seem to be the most effective. International Clinical Recommendations on Scar Management highlight a primary role for silicone and intralesional corticosteroids in the management of a wide variety of abnormal scars including keloids. Silicone is also recommended as first-line prophylaxis for keloid scars. Other options include surgery (high risk of recurrence), radiotherapy, cryotherapy, and laser.

If your skin is keloid prone, you should avoid piercings, tattoo and any unnecessary incisions, such as plastic surgery. You should treat acne thoroughly to reduce lesions and potential for scarring or, if surgery is necessary, silicone may be combined with intralesional steroids or other treatments (above) to reduce the likelihood or size of keloid scarring.

Acne is the most common skin disorder, affecting around 15% of the adult population and up to 80% of adolescents. Facial scarring because of acne occurs to some degree in most cases. The majority of acne scars are flat and depressed below the surrounding skin (atrophic), generally small and often round with an indented or inverted centre. To prevent acne scars, do not pop, squeeze, or pick at acne; do not pull scabs of acne; seek treatment early for acne that does not respond to OTC medications.

Types of Acne Scars:

–          red and/or hyperpigmented marks: a post-inflammatory change that usually disappears in 6-12 months

–          acne scars – icepick: depressed scars, deep, narrow and sharp; usually too deep for dermabrasion or laser skin resurfacing

–          acne scars – boxcar: depressed scars, round with sharp edges

–          rolling acne scars: depressed scars, wavy texture in the skin

–          keloids and hypertrophic scars are raised acne scars that may become larger and more noticeable, sometimes painful and itchy.  

Silicone gel like Strataderm is effective for treatment of acne scars and prevention of keloids and hypertrophic scars. Other effective treatments for depressed acne scars include laser skin resurfacing, dermabrasion, scar surgery (punch excision, punch elevation, punch graft, subcutaneous incision), fillers, chemical peel, microdermabrasion and similar procedures that you should discuss with your dermatologist. For raised acne scars, like keloid and hypertrophic scars, your doctor might consider options like intralesional injections, cryotherapy, surgery, laser and light therapy. Your dermatologist will be able to create a treatment plan based on the type of your acne acne scars, results you can expect, and your medical history.

Acne Scars:

With every wound there are certain individual and environmental factors that influence abnormal scarring (e.g. keloid scars or hypertrophic scars) which make the choice of appropriate scar treatment and scar prevention essential.

Age and Hormonal Influence

Although keloid scars and hypertrophic scars can develop at any age, they tend to develop more readily during and after puberty. Menopause tends to prompt the regression of scarring and pregnancy tends to exacerbate it. Scars from thyroid surgery (thyroidectomy scars) can be problematic due to hormonal changes.

Genetic Factors and Previous History

Abnormal scarring is 15 times more likely to occur in darker-skinned individuals. Keloid scar formation occurs in areas of high melanocyte concentration and is rarely found on the eyelids, genitalia, soles and palms. Individuals with ginger hair and freckles are also at an increased risk of keloid scars. People with a previous personal history of keloid scarring are more likely to scar again in an abnormal fashion and those with a family history are also at an increased risk.

Scar location and surgery technique

Scars over or near muscles that are particularly active often spread or become more visible than the scars formed on less active areas. Skin and wound tension during wound repair is also a contributor to increased scarring.

Wound Infection

Wound infection increases the risk of abnormal scarring.

Type of Skin Injury

A variety of different types of skin injuries can lead to the development of keloid and hypertrophic scarring including surgery, burns and inflammatory skin processes such as acne, psoriasis and chicken pox.

Silicone based products, like Strataderm silicone gel, have been recommended by International clinical recommendations on scar management and have become the standard care for plastic surgeons when it comes to scar treatment and prevention of keloid and hypertrophic scars. Silicone is not only considered first line treatment for scars but it is also recommended for use in conjunction with other scar therapy options, such as corticosteroid injections and pressure garments.

Read more about how to avoid abnormal scars.


Acne is the most common skin disorder in the United States, affecting 40 to 50 million Americans.

It is caused by overproduction of oil, blockage of the follicles that release oil, and bacteria, called Propionibacterium acnes.

 Acne is not caused by chocolate, nuts, cola, pizza, potato chips or any other foods a person eats.

Acne scars are flat and depressed below the surrounding skin, generally small and often round with an indented or inverted centre.

To prevent scars, do not pop, squeeze, or pick at acne; seek treatment early for acne that does not respond to OTC medications.

How to Get Rid of Acne:

Acne Scar Treatment with Fractional CO2 Laser:

Strataderm, a silicone gel for scar treatment is now available on Alice.com. Strataderm is ideal for safe and effective treatment and prevention of scars including:

–       burn scars
–       cesarean sections scars (C-Section scars)
–       acne scars
–       keloid scars
–       hypertrophic scars
–       plastic surgery scars (e.g. breast augmentation scar, rhinoplasty scar, eyelid surgery scar, liposuction scar, tummy tuck scar)
–       scars related to cancer (e.g. mastectomy scar, mole removal scar, melanoma removal scar)

Scars almost always result from trauma of some kind (surgery, accident, disease) and are a natural part of the healing process. The more and the deeper the skin is damaged, the longer and more complicated the rebuilding process – and the greater chance that the patient will be left with a noticeable scar.

A normal scar usually develops during the first 48 hours after wound closure and can fade between 3 and 12 months with an average time of 7 months. Various factors can interfere with the wound healing process and alter it in some way to cause an “overhealing” or continuation of the scarring process. As a result, an abnormal scar develops, which may have the following effects:

  • Grows bigger
  • Remains red/dark and raised without fading
  • Causes discomfort, itching or pain
  • Restricts the movement of a joint
  • Causes distress because of its appearance

Common types of abnormal scars

 Widespread stretched scars

Appear when the fine lines of surgical scars gradually become stretched and widened. Typically flat, pale, soft and symptomless scars. No elevation, thickening or nodularity which distinguishes them from hypertrophic scars.

Linear hypertrophic scars

Red, raised and sometimes itchy. Confined to the border of the original surgery or trauma. Mature to have an elevated, slightly rope-like appearance with increased width. Full maturation can take up to two years.

Widespread hypertrophic scars

Common after a burn. Widespread red, raised and sometimes itchy scars that remain within the borders of the original burn. Can develop contractures if they cross joints or skin creases at right angles.

Atrophic scars

Flat and depressed below the surrounding skin. Generally small and often round with an indented or inverted center. Commonly arise after acne or chickenpox.

Keloid scars

Focally raised, itchy scars that extend over normal tissue. May develop up to several years after injury and do not regress without treatment. Surgical excision is often followed by recurrence.

Keloid Scar

 Scars can have both a physical and psychological impact on individuals.

Scars may cause physical problems like severe itching, tenderness or pain. A wound that crosses a joint or a skin crease may also lead to a scar contracture. Similarly with scars that continue to grow (hypertrophic scars and keloids), they can limit movement and can even be functionally disabling. 

The physical appearance of some scars may also be more obvious as they can continue to be red and raised. Some problematic or abnormal scars may continue to grow past the wound boundaries or may take many years to soften and fade.

At times the psychological aspects can outweigh the physical ones for even the smallest of scars. For some people a scar is a constant reminder of the traumatic event that caused it. This can result in distress, poor self-esteem and difficulties in social situations, all leading to a diminished quality of life. People with scars may feel different and stigmatized and the reaction of others can be hurtful, particularly at impressionable ages. For children and teenagers, scarring can have a major psychological impact. At these ages, there is a need to feel normal or attractive and anything out of the norm can single out the individual. To be different because of scarring may lead to loss of self-confidence and feelings of inferiority.

Read more about scars on Wikipedia.

Possible Functional Issues with scars:

  • sensitivity to heat or cold
  • sensitivity to chemicals
  • sensitivity to sunlight
  • reduced strength and/or endurance
  • difficulty concentrating due to itching, pain, or fatigue
  • skin sensitivity
  • limited range of motion due to contracture
  • shyness in social situations if scars are visible

Any scar can be perceived as a personal problem. Some people learn to accept their scar but many never forget it. Psychologists believe that proactive treatment to reduce the visibility of a scar can boost self-esteem.