1. General introduction 11 1. while the European population is least affected (prevalence of <0.1%).14 However, hypertrophic scars develop much more frequently (prevalence of 32-72%).15 A. B. C. D. Figure 1. A. Keloidal scar: dermis with increased cellularity, particularly fibrohistiocytic cells with intervening vessels and keloidal collagen. B. A 34 year old female patient with multiple keloidal scars on the scapulae. C. Hypertrophic scar: dermis containing intersecting bundles formed by proliferation of fibrohistiocytic cells with a small amount of collagen consistent with hypertrophic scar tissue. D. A 12 year old male patient with a hypertrophic scar on the medial side of the left helix. *All patients have provided written informed consent for publication of their photographs. The histological images (A, C) are provided by the pathology department of Erasmus MC without scale, and do not correspond to the clinical pictures (B, D). Patients with keloids: a heterogeneous population The clinical presentation of keloidal scars highly varies among patients. Patients can have one small keloid that causes minimal symptoms, but patients can also be severely affected with >70 keloids spread over different anatomic locations causing extreme 1 cm 4 cm
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