One of the most intriguing and infuriating problems confronting plastic surgeons is the occurrence of hypertrophic and keloid scars, in some patients – particularly black Africans – but not in others. Many theories have been proposed regarding the cause of keloids – which can ruin a plastic surgeon’s work – but the cause has not as yet been identified. This paper suggests that the basic cause of such scars may lie in the basement membranes of the cells in the papillary dernis. The laboratory study involved the examination of normal epidermal changes on the ultrastructural nature of mature scars, hypertrophic scars and keloid scars from 20 patients. The keloid scars showed changes of the ultrastructure involving the desmosomes of the papillary dermis. The observations support the view that an abnormal permeability barrier remains in keloid scars long after the re-epithelialisation of the wound is completed. Hopefully, the authors of this paper will continue their studies and show why this happens and how it might be prevented. I, and those patients with keloids, cannot wait!

The structure of the basement membrane zone differs between keloids, hypertrophic scars and normal skin: a possible background to an impaired function.
Hellstrom M, Hellstrom S, Engstrom-Laurent A, Bertheim U.

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