Atrophic Scars, Hypertrophic Scares and Keloids.
Scarring is a natural process that occurs when the skin repairs itself after injury, inflammation, or trauma. However, the way the skin heals varies from person to person and depends on factors such as genetics, depth of injury, location of the wound, and post-healing care. Among the most common types of abnormal scarring are atrophic scars, hypertrophic scars, and keloids, each presenting unique characteristics, causes, triggers, and treatment approaches.
How Scars Forms.
Whenever the skin sustains an injury, whether through acne, surgery, burns, trauma, or infections, the body repairs the wound by producing collagen.
The type, amount, and arrangement of collagen fibres determine how the final scar appears.
Scar formation involves three stages:
- Inflammatory Phase: The body begins managing tissue damage, swelling, and redness.
- Proliferative Phase: Fibroblasts produce collagen to rebuild lost tissue.
- Remodelling Phase: The collagen matures and reorganizes over months to years to create the final scar.
When this process becomes excessive or insufficient, different scar types emerge.
Atrophic Scars
Atrophic scars occur when there is insufficient collagen production during the wound-healing process. This causes the skin to heal below the natural surface level, leading to depressions or indentations.
Reason for Atrophic Scars Formation.
Excess sebum production, often driven by hormonal fluctuations, especially during puberty, menstrual cycles, pregnancy, or stress, creates an oily environment in which pores become easily clogged; when this overproduction continues unchecked, it forms the perfect foundation for more severe acne lesions that can later collapse into depressive scars.
Follicular hyperkeratinization, a process in which dead skin cells fail to shed normally and instead accumulate inside the pores, combines with sebum to form comedones; these blocked pores can then evolve into inflammatory acne if bacteria become involved, setting the stage for tissue breakdown.
Cutibacterium acnes (C. acnes) bacteria, which naturally live on the skin, multiply rapidly when trapped inside clogged pores; their presence triggers an immune response that leads to redness, swelling, and sometimes deep nodules or cysts, and these deep lesions are the primary culprits behind the dermal destruction that ultimately leads to atrophic scarring.
Common Causes of Atrophic Scars
Acne (most common cause)
Chickenpox lesions
Infectious skin diseases
Surgical wounds that heal poorly
Trauma such as cuts or bites
Types of Atrophic Scars
- Ice-Pick Scars: Deep, narrow, V-shaped scars.
- Boxcar Scars: Defined edges with a box-like appearance.
- Rolling Scars:Wave-like, shallow depressions caused by tethering of the skin.
Hypertrophic Scars.
Hypertrophic scars occur when the body produces too much collagen, causing a raised scar that remains restricted to the boundaries of the original wound.
Key Features
Raised, firm, and sometimes itchy
Red or pink during early stages
May improve over months to years with proper care
Often caused by excessive tension during wound healing
Common Causes
Surgical incisions
Burns
Trauma (cuts, piercings, abrasions)
Infected or poorly managed wounds
Risk Factors
Younger age (more active collagen response)
Location, chest, shoulders, back, and jawline are high-tension areas
Darker skin tones have a higher predisposition
Keloids.
Keloids are overgrowths of scar tissue that extend beyond the boundaries of the original wound. They are the result of unregulated collagen production, making them more aggressive than hypertrophic scars.
Characteristics
Firm, thick, shiny, raised nodules or plaques
Frequently painful or itchy
Continue growing over months to years
Do not regress spontaneously
Common on: chest, shoulders, upper back, jawline, and earlobes
Reasons Keloids Form.
Genetic predisposition
Darker skin types (Fitzpatrick IV–VI) have a higher risk
Excessive collagen synthesis is triggered by injury
Inflammatory conditions like acne or folliculitis
Repetitive trauma, e.g., earrings in the same hole
Tension-prone areas where the skin is tight
Atrophic vs. Hypertrophic Scars vs. Keloids: Quick Comparison
Scar Type Collagen Activity Key Features Growth Area Causes Treatment Response
Atrophic Low collagen Depressed, sunken scars Within wound Acne, infections, surgery Excellent with collagen-stimulating treatments
Hypertrophic Excess collagen Raised but within wound Limited to wound site Burns, surgery, trauma Good response to steroids & silicone
Keloids Excess, uncontrolled collagen Raised, firm, extends beyond wound Spreads outward Genetic, tension, skin type Difficult; requires multimodal therapy
Emil Spa Prevention Tips for All Scar Types
To minimize abnormal scarring:
Clean and treat wounds promptly
Avoid picking, squeezing, or scratching
Use sunscreen daily to prevent dark scars
Apply silicone gel/sheets during the healing period
Reduce tension on fresh wounds
Treat acne early and effectively
Avoid risky piercings if prone to keloids
Professional Takeaway from Emil Spa
Understanding these three scar types, atrophic, hypertrophic, and keloids , enables clients and practitioners to choose treatments that are scientifically appropriate and clinically effective. At Emil Spa, we prioritize personalized treatment plans, modern technology, and a results-driven approach to help you achieve smooth, healthy, confident skin.
Skin Repair
Keloid Scars
Excessive collagen
Atrophic Scars
Hypertrophic Scares
Acne Management
Scars Formation.
Atrophic Scars, Hypertrophic Scares and Keloids.
Scarring is a natural process that occurs when the skin repairs itself after injury, inflammation, or trauma. However, the way the skin heals varies from person to person and depends on factors such as genetics, depth of injury, location of the wound, and post-healing care. Among the most common types of abnormal scarring are atrophic scars, hypertrophic scars, and keloids, each presenting unique characteristics, causes, triggers, and treatment approaches.
How Scars Forms.
Whenever the skin sustains an injury, whether through acne, surgery, burns, trauma, or infections, the body repairs the wound by producing collagen.
The type, amount, and arrangement of collagen fibres determine how the final scar appears.
Scar formation involves three stages:
When this process becomes excessive or insufficient, different scar types emerge.
Atrophic Scars
Atrophic scars occur when there is insufficient collagen production during the wound-healing process. This causes the skin to heal below the natural surface level, leading to depressions or indentations.
Reason for Atrophic Scars Formation.
Excess sebum production, often driven by hormonal fluctuations, especially during puberty, menstrual cycles, pregnancy, or stress, creates an oily environment in which pores become easily clogged; when this overproduction continues unchecked, it forms the perfect foundation for more severe acne lesions that can later collapse into depressive scars.
Follicular hyperkeratinization, a process in which dead skin cells fail to shed normally and instead accumulate inside the pores, combines with sebum to form comedones; these blocked pores can then evolve into inflammatory acne if bacteria become involved, setting the stage for tissue breakdown.
Cutibacterium acnes (C. acnes) bacteria, which naturally live on the skin, multiply rapidly when trapped inside clogged pores; their presence triggers an immune response that leads to redness, swelling, and sometimes deep nodules or cysts, and these deep lesions are the primary culprits behind the dermal destruction that ultimately leads to atrophic scarring.
Common Causes of Atrophic Scars
Acne (most common cause)
Chickenpox lesions
Infectious skin diseases
Surgical wounds that heal poorly
Trauma such as cuts or bites
Types of Atrophic Scars
Hypertrophic Scars.
Hypertrophic scars occur when the body produces too much collagen, causing a raised scar that remains restricted to the boundaries of the original wound.
Key Features
Raised, firm, and sometimes itchy
Red or pink during early stages
May improve over months to years with proper care
Often caused by excessive tension during wound healing
Common Causes
Surgical incisions
Burns
Trauma (cuts, piercings, abrasions)
Infected or poorly managed wounds
Risk Factors
Younger age (more active collagen response)
Location, chest, shoulders, back, and jawline are high-tension areas
Darker skin tones have a higher predisposition
Keloids.
Keloids are overgrowths of scar tissue that extend beyond the boundaries of the original wound. They are the result of unregulated collagen production, making them more aggressive than hypertrophic scars.
Characteristics
Firm, thick, shiny, raised nodules or plaques
Frequently painful or itchy
Continue growing over months to years
Do not regress spontaneously
Common on: chest, shoulders, upper back, jawline, and earlobes
Reasons Keloids Form.
Genetic predisposition
Darker skin types (Fitzpatrick IV–VI) have a higher risk
Excessive collagen synthesis is triggered by injury
Inflammatory conditions like acne or folliculitis
Repetitive trauma, e.g., earrings in the same hole
Tension-prone areas where the skin is tight
Atrophic vs. Hypertrophic Scars vs. Keloids: Quick Comparison
Scar Type Collagen Activity Key Features Growth Area Causes Treatment Response
Atrophic Low collagen Depressed, sunken scars Within wound Acne, infections, surgery Excellent with collagen-stimulating treatments
Hypertrophic Excess collagen Raised but within wound Limited to wound site Burns, surgery, trauma Good response to steroids & silicone
Keloids Excess, uncontrolled collagen Raised, firm, extends beyond wound Spreads outward Genetic, tension, skin type Difficult; requires multimodal therapy
Emil Spa Prevention Tips for All Scar Types
To minimize abnormal scarring:
Clean and treat wounds promptly
Avoid picking, squeezing, or scratching
Use sunscreen daily to prevent dark scars
Apply silicone gel/sheets during the healing period
Reduce tension on fresh wounds
Treat acne early and effectively
Avoid risky piercings if prone to keloids
Professional Takeaway from Emil Spa
Understanding these three scar types, atrophic, hypertrophic, and keloids , enables clients and practitioners to choose treatments that are scientifically appropriate and clinically effective. At Emil Spa, we prioritize personalized treatment plans, modern technology, and a results-driven approach to help you achieve smooth, healthy, confident skin.
Skin Repair
Keloid Scars
Excessive collagen
Atrophic Scars
Hypertrophic Scares
Acne Management
Scars Formation.