EWJ June 61 2025 web - Flipbook - Page 71
Scars – Combination Strategies
for Prevention and Treatment
Mr. Raj Ragoowansi is a highly experienced medico-legal expert with over 20 years of
experience in preparing comprehensive, evidence-based reports for personal injury and clinical
negligence cases.
Mr. Ragoowansi provides 120-150 medico-legal reports annually covering a broad range of
fields but mainly specialising in scars.
Keloid:
Growth: Extends beyond the original wound's boundaries and can grow aggressively.
Pathophysiology of scars
Wound healing occurs as a response to disruption of
the epidermis and dermis. It is an intricate and wellorchestrated response with the goal to restore skin
integrity and function.
Appearance: Raised, hard, smooth, and shiny, can be
skin-coloured or darker than surrounding skin.
Histology: Collagen fibres are often disorganized and
may contain hyalinized collagen bundles.
Progression: Generally does not regress spontaneously and can persist for a long time.
Symptoms: Can be itchy, painful, or even cause
hyperesthesia.
However, skin wound healing may result in abnormal
scarring, including keloid lesions or hypertrophic
scars. The underlying mechanisms of hypertrophic
scars and keloid lesions have been extensively researched, including Mr Ragoowansi’s own scientific
and clinical research, which suggests that the changes
in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting
in fibrotic/lumpy/pigmented scars.
The lesions then become established, with ongoing
deposition of excess disordered collagen.
Types of scars
Hypertrophic Scar:
Growth: Remains confined to the original wound's
borders.
Appearance: Typically thick, raised, and red or brown
in colour.
Histology: Collagen fibres are generally arranged in
a wavy, regular pattern.
Progression: May initially thicken or rise for a few
months, then gradually fades and flattens over 1-2
years.
Symptoms: Can be itchy or painful.
Above, Keloid scar
Key Differences between hypertrophic and keloid
scars:
Growth Boundaries: Hypertrophic scars stay within
the wound, while keloids spread.
Regression: Hypertrophic scars can regress, keloids
do not.
Histology: Hypertrophic scars have a more organized
collagen structure, keloids are more disorganized.
Progression: Hypertrophic scars have a more defined
growth and maturation phase, keloids are often more
persistent.
In summary, the main difference lies in the growth
pattern and the ability to regress. Hypertrophic scars
are contained and may fade, while keloids extend and
do not typically regress.
Above, Hypertrophic Scar
EXPERT WITNESS JOURNAL
69
JUNE 2025
