Papers of The 3rd Japan Scar Workshop

3. Classification and evaluation of hypertrophic scars and keloids - proposal of a new scoring method

Yasuyoshi TOSA, Yoshiaki HOSAKA, Kiyoaki TSUTSUMI
Toshiya YOKOYAMA, Kaneshige SATOH
Department of Plastic and Reconstructive Surgery, Showa University School of Medicine, Tokyo 142-8666, Japan

Hypertrophic scars and keloids develop as a result of wounds such as traumas, burns and surgical operations, and they are raised lesions accompanied by long-term pruritus and pain. We usually classify and evaluate hypertrophic scars and keloids using a scoring method based on signs (color, projection and hardness of the scar), symptoms (the intensities of itchiness, tenderness and pain), and the presence of adverse reactions.
We considered that it may be useful to score the patient’s “keloidal character” when determining the level of resistance to treatments. In this study, we attempted to score the factors that are related to keloidal character. We chose seven factors: presence of keloids in the family, the condition of the BCG vaccination site on the patient, the condition of old wounds on the patient, site of the scar that is to be treated, the wound healing process, presence of an adverse reaction to a conservative treatment (adverse event following oral administration of tranilast and/or dermatitis due to silicone materials), and racial background. An initial score of 1 was assigned, and a score of 0.5, 0.25 or 0 was assigned for each factor. We believe it is possible to estimate the progress of a patient following surgery to a certain extent if we accumulate data and determine the threshold score for resistance to treatments. We expect the keloidal character scoring method proposed in this report to provide useful information for estimating the likelihood of redevelopment of a lesion following surgery, and for determining the dose in postoperative electron-beam irradiation therapy.
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