Hypertrophic and keloid scars are usually easy to diagnose clinically. Although there is no ideal therapy for these scars, intralesional corticosteroids are the most commonly used treatment.
A 40-year-old woman of Maltese background presented with a painful, large and unsightly keloid that had spontaneously formed on her lower sternal area nine years ago (Figure). The scar had gradually enlarged over time and there were two other small nodular keloids nearby. The patient had no past history of injury, acne or folliculitis for the sternal keloids and, apart from some mild discoid pattern dermatitis on her hands, had no other skin problems.
The patient had a 14-year history of keloid scars. The first scar formed five months after a caesarian section during the birth of her second child. It was mildly pruritic, but as it did not become particularly thick or troublesome, the patient did not seek treatment for this scar.