Classification and clinical features of hypertrophic scars and keloids

Scar type	Characteristics*	Maturation
Mature	Light in color Flat
Immature	Red Pruritic Painful Slightly elevated, indicating remodeling	Many mature in time Become flat Pigmentation generally similar to surrounding skin Pigmentation may be paler or darker than skin
Linear, hypertrophic Example: Surgical or traumatic scar	Red Raised Pruritic Confined to the border of the original scar Generally matures to an elevated, slightly rope-like appearance Mature scar has increased width (variable)	Increases in size rapidly for first 3 to 6 months After a static phase, regresses Full maturation in approximately 2 years
Widespread, hypertrophic Example: Burn scar	Widespread Red Raised Pruritic Remains within the borders of the burn injury
Minor keloid	Focally raised Pruritic Extends beyond burn borders May have genetic component for keloid development Typical site: Earlobes	May develop 1 year after burn Does not regress spontaneously Recurrence generally follows surgical excision
Major keloid	Large (>0.5 cm) Painful Pruritic Extends beyond burn borders over normal tissue Can result even from minor trauma	Does not spontaneously regress Can continue to progress in size over years

* Characteristics may be variable in symptoms (eg, pruritus, pain) for each patient.

From: Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110:560. Adapted with permission from Lippincott Williams & Wilkins. Copyright © 2002 American Society of Plastic Surgeons, Inc. Unauthorized reproduction of this material is prohibited.

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Classification and clinical features of hypertrophic scars and keloids