Risk Factors Associated with the Development of Pathological Scarring in Patients with Cutaneous Wounds
DOI:
https://doi.org/10.66201/ss.v1.21Keywords:
Keloid, Risk Factors, Mechanotransduction, Dermal Fibrosis, Extracellular Matrix, Narrative Review, Pathological Scarring, Hypertrophic ScarAbstract
Background: Pathological scarring, including hypertrophic scars and keloids, affects 10–15% of all cutaneous wounds and represents a significant clinical burden worldwide. Its occurrence depends on the interaction of host, local, and molecular factors that alter the physiological process of tissue repair.
Methods: A narrative review of the literature was conducted with searches in PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and Web of Science. Studies published between January 2020 and April 2025 were included, prioritizing clinical trials, prospective cohorts, meta-analyses, and systematic reviews with verified quantitative data.
Results: Documented risk factors include host components (genetic predisposition, dark skin phototype, young age, elevated body mass index, and systemic comorbidities), local factors (mechanical tension, high-tension anatomical location, wound depth, healing delay exceeding 21 days, and infection), and molecular mechanisms (aberrant TGF-β signaling, inflammasome activation, and mechanotransduction via FAK/ERK). In cohorts of 328 to 4,238 patients, sternal location and personal history of keloid were the most potent independent predictors.
Conclusion: Pathological scarring results from the convergence of multiple identifiable risk factors before and during wound management. Preoperative risk stratification and minimization of local tension constitute the preventive interventions with the strongest support in current evidence.
References
Carr NJ. A patologia da cicatrização e reparação. Ciências Básicas. 2022;40(1):13–19. Disponible en: https://www.surgeryjournal.co.uk/article/S0263-9319(21)00237-4/abstract
Hu X, Qiu T. Logistic regression analysis of risk factors influencing postoperative keloid scar recurrence. Am J Transl Res. 2024;16(9):4849–4857. doi: 10.62347/CZYH2768. PMID: 39398575; PMCID: PMC11470296. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC11470296/
Katano A, Minamitani M, Yamashita H. Risk factors for local recurrence of keloids and hypertrophic scars after postoperative electron beam radiotherapy. J Cancer Res Ther. 2024;20(1):163–166. doi: 10.4103/jcrt.jcrt_1861_22. Epub 2023 Apr 7. PMID: 38554315. Disponible en: https://journals.lww.com/cancerjournal/fulltext/2024/20010/risk_factors_for_local_recurrence_of_keloids_and.25.aspx
Bogaski LRS, Santos ALT, Santin MA, Bezerra LF. Tratamento para queloides: revisão de literatura. Arquivos de Revistas de Saúde. 2024;3:e2088. doi: 10.46919/archv5n3espec-401. Disponible en: https://ojs.latinamericanpublicacoes.com.br/ojs/index.php/ah/article/view/2088
Barros LFL, et al. Tratamento de queloides e cicatrizes hipertróficas: uma revisão descritiva. Rev Bras Cir Plast [Internet]. 2023;38(4):[artigo e-paginação não informada]. doi: 10.5935/2177-1235.2023RBCP0749-PT. Disponible en: https://www.scielo.br/j/rbcp/a/Gn5VLhKrQt8RWpt78b9y97Q/?lang=pt
de Menezes BF, et al. Alternativas para o tratamento de cicatrizes queloidianas. Revista Internacional de Estudos e Pesquisas em Tratamento de Feridas. 2022;14(2):[artigo e220052]. doi: 10.31034/2655-7022/2022/220052. Disponible en: https://www.redalyc.org/journal/2655/265570220052/pdf/
Oliveira GV, Metsavaht LD. ASAP - O primeiro algoritmo para tratar queloides e cicatrizes hipertróficas. Dermatologia Cirúrgica e Cosmética. 2022;14(1). ISSN: 1984-5510. Disponible en: https://www.redalyc.org/articulo.oa?id=265570220019
Barragán Vinueza ED, Salgado Calderón AM, Gavilanes Benavides EL, Alegría Balseca MA, Espinoza Mena DP, Soria Cortez YF, et al. Manejo de las cicatrices hipertróficas y queloides: enfoques actuales. Ibero-American Journal of Health Science Research. 2025;5(1):221–230. doi: 10.56183/iberojhr.v5i1.723. Disponible en: https://health.iberojournals.com/index.php/IBEROJHR/article/view/723
Elsaie ML. Atualização sobre o tratamento de cicatrizes queloides e hipertróficas: uma revisão sistemática. J Cosmet Dermatol. 2021;20:2729–2738. doi: 10.1111/jocd.14310. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocd.14310
Frech FS, Hernandez L, Urbonas R, et al. Cicatrizes hipertróficas e queloides: avanços no tratamento e revisão das terapias estabelecidas. Am J Clin Dermatol. 2023;24:225–245. doi: 10.1007/s40257-022-00744-6. Disponible en: https://link.springer.com/article/10.1007/s40257-022-00744-6
Limandjaja GC, Niessen FB, Scheper R, Gibbs S. Cicatrizes hipertróficas e queloides: visão geral das evidências e guia prático para diferenciar entre essas cicatrizes anormais. Exp Dermatol. 2021;30:146–161. doi: 10.1111/exd.14121. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/exd.14121
Xie P, Xiang Y, Yang E, Zhang H. Fatores que influenciam a formação de cicatrizes hipertróficas após tireoidectomia. Adv Skin Wound Care. 2021;34(10):1–6. doi: 10.1097/01.ASW.0000775924.92065.78. Disponible en: https://journals.lww.com/aswcjournal/fulltext/2021/10000/factors_influencing_hypertrophic_scarring_after.10.aspx
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol. 2021;74(9):790–799. doi: 10.1016/j.recesp.2021.06.016. Disponible en: https://www.sciencedirect.com/science/article/pii/S0300893221002748
Cho MY, Lee SG, Kim JE, Lee YS, Chang HS, Roh MR. Analysis of risk factors to predict occurrence and prognosis of postsurgical hypertrophic scar development: a review of 4238 cases. Yonsei Med J. 2023;64(11):687–691. doi: 10.3349/ymj.2023.0003. PMID: 37880850; PMCID: PMC10613765. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC10613765/
Bağlı İ, Ogawa R, Bakır S, Taşın C, Yıldırım A, Öcal E, et al. Predictors of the recurrence of surgically removed previous caesarean skin scars at caesarean section: a retrospective cohort study. Scars Burn Heal. 2021;7:20595131211023388. doi: 10.1177/20595131211023388. PMID: 34262789; PMCID: PMC8246489. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC8246489/
Villafuerte-Vélez CK, Castro-Cabrera AC, Restrepo-Villafuerte C. Corticoterapia profiláctica transquirúrgica de la hiperplasia cicatricial: estudio clínico-estadístico prospectivo. Cir Plást Iberolatinoam. 2017;43(1):33–39. Disponible en: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0376-78922017000100005&lng=es
Shaheen A, Khaddam J, Kesh F. Risk factors of keloids in Syrians. BMC Dermatol. 2016;16(1):13. doi: 10.1186/s12895-016-0050-5. PMID: 27646558; PMCID: PMC5028955. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5028955/
Hellwege JN, Russell SB, Williams SM, Edwards TL, Velez Edwards DR. Genebased evaluation of low-frequency variation and genetically-predicted gene expression impacting risk of keloid formation. Ann Hum Genet. 2018;82(4):206–215. doi: 10.1111/ahg.12245. PMID: 29484647; PMCID: PMC5993571. Disponible en: https://pmc.ncbi.nlm.nih.gov/articles/PMC5993571/
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Copyright (c) 2026 Gabriella Silva de Oliveira, Sibeli Cristina Pinto Ferreira, Vitória Caroline Dos Santos Malta Bezerra, Alexandra Vitória Martins da Silva, Abigail Gonçalves da Silva, Tamara Barbosa Barros, Alana de Oliveira Alana de Oliveira, Italy Dos Santos Francisco, Paola Britos (Autor/a)
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