Both hypertrophic scars and keloids have a tendency to itch; keloids are sometimes tender and painful. They are overgrowths of fibrous tissue at the sites of trauma or inflammatory disease processes. Keloids and hypertrophic scars present as firm papular or nodular lesions. The shoulders, upper trunk, ear lobes, chin, neck, and the lower part of the legs are the favored sites.

Keloids begin in a site of trauma, but continue to grow for prolonged periods of time, often extending many centimeters beyond the initial site to form large elevated mesa-like plaques (Fig. 55-1). Keloids may also appear as knobby individual lesions, dome-shaped nodules that resemble cobblestones, or irregular shiny plaques from which ridge-like bands and cords extend like pseudopods. The surface may be reddish or purplish at first and later hyper or hypopigmented. Lesions located over joints can seriously interfere with
function. Keloid susceptibility is sometimes familial; the condition is more common in dark-skinned individuals.