In 2005 I wrote a paper with my colleague Linda Huang which looked at keloid and hypertrophic scars from a rather different perspective (Burd A, Huang L. Hypertrophic response and keloid diathesis: two very different forms of scar. Plast Reconstr Surg 2005;116(7):150e-157e). Indeed, we did propose that there is unlikely to be a single modality that would effectively treat all pathological scarring. Our thoughts are that eventually scars will undergo a molecular characterisation, not a clinical one, and that the treatment will be targeted to the specific molecular anomaly.
In a follow-up Editorial in JPRAS I did observe that in burns patients it is possible to find the two main types of pathological scarring existing concurrently in the same patient (Burd A. So what is a keloid scar? J Plast Reconstr Aesthet Surg 2008;61(1):1-3). It is good to find papers that are still looking for answers and I would encourage the inclusion of these two papers in unit journal clubs (if they still exist!)