# Keloid and Hypertrophic Scar - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: International Advisory Panel on Scar Management: Clinical recommendations on scar management 2014 · NICE CKS: Scars 2021 · Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) · Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) · Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) · Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt) - Verified date: 2026-08 ## Verified against - Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) - Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) - Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) - No dose - referral pathway, no medicine given in primary care - Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt) ## Treatment metadata - Silicone — topical - Triamcinolone — 40 mg — injection - Referral & safety-netting (no drug therapy) - Verapamil — 2.5 mg — injection ## Complete treatment card ```text KELOID AND HYPERTROPHIC SCAR Sources: International Advisory Panel on Scar Management: Clinical recommendations on scar management 2014 · NICE CKS: Scars 2021 · Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) · Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) · Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) · Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt) Review status: REVIEWED against Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org), Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route), Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC), No dose - referral pathway, no medicine given in primary care, Hypertrophic Scarring Keloids - StatPearls - NCBI Bookshelf - disease-level clinical article (keloid-scar-full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (8) - Lesions itch frequently and can be sore [itching] - Soreness and itch point towards keloid rather than a hypertrophic scar [itching · keloid] - Relatives are often affected, since there is a strong inherited tendency to form keloid [keloid] - Keloids may follow an injury or arise with no injury at all [keloid] - A keloid emerges roughly three months after injury and then keeps enlarging without settling [keloid] - A hypertrophic scar shows up inside the first month and starts shrinking after half a year [scarring] - A scar getting better on its own suggests hypertrophic scar, because keloid does not regress [keloid · scarring] - With no preceding injury, hypertrophic scar is unlikely: it is only ever post-traumatic [scarring] SIGNS - what you find (7) - Both are raised, thickened scars, richer in cells and carrying collagen nodules [scarring] - The defining feature: a keloid spreads past the edge of the initial scar; one contained inside those edges is not a keloid [keloid · scarring] - A hypertrophic scar stays inside the wound edge and is the commoner of the two [scarring] - Usual keloid sites are earlobe, shoulder, chest, back, cheek and knee [keloid] - Hypertrophic scars favour extensor surfaces, where skin tension is higher [scarring] - Keloid is commoner in darker skin tones; hypertrophic scar occurs across every skin type [keloid · scarring] - Recurrence after excision is high for keloid and much lower for hypertrophic scar [keloid · relapse · scarring] TESTS (4) - Take a biopsy whenever the diagnosis is in any doubt - Collagen lies in parallel in hypertrophic scar but in a disordered whorl in keloid - Hypertrophic scar has thin fibres with more type III than type I collagen; keloid is mostly thick type I - Myofibroblasts and alpha-smooth muscle actin appear in hypertrophic scar and are missing from keloid IF NOT THIS - what else fits (8) - Dermatofibrosarcoma protuberans, showing storiform spindle cells in a honeycombed fibrous stroma - Trichilemmal carcinoma, a rare adnexal tumour arising from hair follicles - Keloidal basal cell carcinoma, which also carries thick keloid-type collagen bundles - Giant cell fibroblastoma, reported misdiagnosed as keloid in a child of nine - Cutaneous scleroderma, with a thickened dermis and pigmented keloid-like plaques, which may signal systemic disease - Sclerotic neurofibroma, identified by positive protein S100 - Hair folliculitis, bacterial or fungal, where steroid is contraindicated - Exclude malignant mimics before treating, because steroid is contraindicated in tumour yet is the mainstay for keloid Source StatPearls "Hypertrophic Scarring Keloids" - disease-level clinical article Status traced to the source above Rx: First line - self-applied | Intralesional injection | Main treatment FIRST LINE - SELF-APPLIED 1. SILICONE [1st line] Adult Apply silicone gel or sheeting to clean dry scar, worn at least 12 hours a day and ideally continuously for 24 with twice-daily washing - At least 1 month, usually a 2-month course, with review at 8-12 weeks for a keloid Peds Apply silicone gel or sheeting twice daily to affected scar area in children for 3-6 months. Source Gold MH et al., Updated international clinical recommendations on scar management, part 2, Dermatol Surg 2014 (full text at laserplast.org) Why Occlusive sheeting or gel that hydrates the stratum corneum and reduces the mechanical and inflammatory stimulus driving fibroblast collagen production, softening and flattening the scar. First-line non-invasive option before considering injections. Caution First-line non-invasive therapy for prevention and management of hypertrophic scars and early keloids. Do not apply to open wounds, unhealed surgical incisions, or broken skin. Ensure skin is clean and dry before application to prevent skin maceration or contact dermatitis. Egypt SCAR NOT GEL 30 GM LEVEN > VIDA ... 555.00 EGP SCAR NOT GEL 30 GM LEVEN > VIDA ... 555.00 EGP SCAR NOT 15 MG 15GRAM LEVEN > VIDA ... 330.00 EGP INTRALESIONAL INJECTION 2. TRIAMCINOLONE [1st line] Adult Dilute first. Egypt sells triamcinolone only as a 40 mg/mL intramuscular ampoule; the 10 mg/mL intralesional presentation the formulary lists is not on the register. Dilute with lidocaine or saline to 10-20 mg/mL for the body and 5-10 mg/mL for the face - that is 1 part ampoule to 1, 3 or 7 parts diluent. Inject into the scar mass, not under it, every 4-6 weeks - Repeat every 4-6 weeks for up to 3-6 sessions Peds Intralesional injection in children (5-10 mg/mL) reserved for resistant keloids under specialist dermatology oversight. Source Egyptian National Drug Formulary - Endocrine System 2024 (triamcinolone monograph, intralesional route) Why Intralesional corticosteroid injected directly into the scar mass to suppress fibroblast proliferation and collagen synthesis, flattening established keloids. First-line invasive treatment once non-invasive measures like silicone have failed. Caution Never inject the ampoule neat into a facial keloid. The only strength sold here is 40 mg/mL and the face wants 5-10 - undiluted it causes skin atrophy, a permanent depressed patch, and telangiectasia. First-line invasive treatment for established active keloids and refractory hypertrophic scars. Inject strictly intralesionally; extravasation into surrounding subcutaneous tissue causes skin atrophy, telangiectasia, and hypopigmentation. Multiple injections over several months are often required; recurrence rate remains 30-50% if used as monotherapy. The formulary's own intralesional figures are 20-60 mg into the lesion, distributed as repeated 20-40 mg injections for a large one, and one to four injections in total. Those are milligrams delivered, not concentration - both have to be right. Egypt PHARCOCINOLONE 40MG/ML I.M AMP. CHEMIPHARM > ... 8.00 EGP AMCINOL 40MG/ML I.M AMP. SIGMA TEC 11.00 EGP EPIRELEFAN 40MG/ML I.M AMP. EIPICO 38.00 EGP SYNTHECORTIN 40MG/ML I.M AMP. MUP 54.00 EGP MAIN TREATMENT - choose one 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source No dose - referral pathway, no medicine given in primary care Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - Malignant mimickers and infections must be excluded before steroid therapy as steroids are contraindicated. A thickened, hyperpigmented, keloid-like plaque may be cutaneous scleroderma; treating it as a scar misses an underlying systemic disease. Dermatofibrosarcoma protuberans and other cutaneous malignancies can look exactly like a keloid. If the diagnosis is in any doubt, obtain a biopsy before treating. Keloids and hypertrophic scars should be managed with a dermatologist, to prevent further enlargement and the functional disability these scars can cause. 4. VERAPAMIL [2nd line] Adult Intralesional injection of 2.5 mg/mL (0.5-2 mL per session) injected directly into keloid tissue every 3-4 weeks - Repeat every 3-4 weeks for up to 4-6 sessions Peds Intralesional verapamil in pediatric keloids under specialist dermatology advice. Source Wang R et al., intralesional verapamil for keloid and hypertrophic scar, Int Wound J (PMC) Why Calcium-channel blocker injected directly into keloid tissue as an add-on alongside, or an alternative to, intralesional corticosteroid; it does not replace corticosteroid as the first-line invasive option, but suppresses fibroblast collagen synthesis with a lower risk of the skin atrophy steroids can cause. Caution Alternative intralesional therapy that inhibits collagen synthesis with lower risk of tissue atrophy compared to corticosteroids. Monitor for localized erythema, burning, or systemic hypotension if large volumes are injected. The dose rests on the trial literature. The scar-management guideline does not mention verapamil anywhere. Egypt IZOPTOMIL 2.5MG/ML 5 AMP. FOR I.V. INJ. MEMPHIS > ARAB DRUG COMPANY (ADCO) 17.50 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)