They are more common on the skin of the presternal area, neck, ears and proximal limbs. During normal wound healing, from three days to three weeks, a period of proliferation occurs during which collagen deposition exceeds collagen lysis. There then follows a period of equilibrium before a late phase of remodeling occurs. During this later phase collagen lysis exceeds collagen deposition and scar thins. The strength of the scar is maximal at four to six weeks.
Remodelling is complete by one year.
In keloid scar formation this ordered sequence is deranged with collagen deposition far exceeding lysis. No treatment of keloids has been shown to be uniformly effective. Surgery is unfortunately associated with a high risk of recurrence. It may be of use in keloids that occur as a result of post-operative wound infection or from poorly placed incisions. If further surgery is contemplated post-operative pressure from elastic compression garments may help to prevent recurrence.