Keloids and hypertrophic scars: update and future directions.

Area of Science:

• Dermatology
• Pathology
• Wound Healing Research

Background:

• Pathological scars like hypertrophic scars (HSs) and keloids arise from complex, incompletely understood wound healing processes.
• Current classifications and research are hindered by simplistic views of aberrant wound healing and collagen characteristics.
• Elucidating the precise mechanisms of scar initiation, evolution, and regulation is a significant clinical challenge.

Purpose of the Study:

• To review recent findings on the pathology and pathogenesis of HSs and keloids.
• To examine aberrations in wound healing phases (inflammation, proliferation, remodeling) specific to these scars.
• To detail current hypotheses on pathological scar etiology for further investigation.

Main Methods:

• Literature review focusing on recent advancements in scar pathology and pathogenesis.
• Analysis of the roles of extracellular matrix, epidermis, and dermis in scar formation.
• Compilation and examination of current etiological hypotheses for pathological scars.

Main Results:

• Aberrations in inflammation, proliferation, and remodeling phases contribute to HS and keloid development.
• Extracellular matrix composition and interactions within skin layers are critical in scar pathogenesis.
• Effective therapies are emerging, some directly linked to etiological insights.

Conclusions:

• A deeper understanding of pathological scar etiology and manifestations is essential for improved classification and treatment.
• Further research is needed to fully elucidate the complex mechanisms underlying HSs and keloids.
• Translating etiological understanding into targeted therapies promises better patient outcomes.