Dermatology: Practical and Conceptual


Research Letter | Dermatol Pract Concept. 2025;15(4):5315 1

Dermatoscopic Patterns in Keloid, Hypertrophic, 
and Atrophic Scars: Cross-Sectional Analysis and 

Clinical Correlation
Leonne Del Vecchio1,2, Jan Lapinso3, Leandra d’Orsi Metsavah4, Geise Cristine Espíndola5, 
Elizabeth Leocadia Fernandes4, Keila Seabra Teles Ferreira6, Marcio Roberto Silva9, Jussara 

Aparecida da Silva9, Gisele Viana de Oliveira5,7,8

1 University of Taubaté, Bom Conselho, Taubaté, Brazil

2 Hospital Municipal Universitário de Taubaté, Brazil

3 Department of Dermatology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Swedenl

4 Metsavaht Dermatology and Santa Casa Hospital, Rio de Janeiro, Brazil

5 Luxemburgo/Mário Penna Hospital, Dermatology Department, Belo Horizonte, Brazil

6 Medical Sciences University of Minas Gerais, Postgraduate Department, Belo Horizonte, Brazil

7 GV Dermatology, Belo Horizonte, Brazil

8 University of Minas Gerais, Postgraduate Department, Belo Horizonte, Brazil

9 University of Juiz de Fora, Postgraduate Department in Collective Health, Juiz de Fora, Brazil

Key words: Dermatoscopy; Keloid, Hypertrophic scar, Vascular patterns; Scar maturation

Citation: Metsavah LdO, Espíndola GC, Fernandes EL, et al. Dermatoscopic Patterns in Keloid, Hypertrophic, and Atrophic Scars:  
Cross-Sectional Analysis and Clinical Correlation. Dermatol Pract Concept. 2025;15(4):5315. DOI: https://doi.org/10.5826/
dpc.1504a5315

Accepted: February 20, 2025; Published: October 2025

Copyright: ©2025 Metsavah et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing Interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding Author: Leonne Del Vecchio, Medical Resident at the Dermatology Department, University of Taubaté, and Hospital 
Municipal Universitário de Taubaté, Brazil. E-mail: leonnedicarlo.derma@gmail.com

Introduction

Keloids, hypertrophic scars, and atrophic scars represent 

distinct forms of abnormal wound healing. Differentiating 

between these entities is often based on clinical and histo-

pathological criteria. Dermatoscopy has been suggested 

as a supportive tool in this differentiation, yet published 

data remain limited. While earlier studies proposed that 

dermatoscopy could assist in distinguishing scar subtypes, 

we aimed to clarify its role by analyzing a broad set of der-

matoscopic images. Our findings demonstrate that derma-

toscopy is more effective for evaluating scar activity and 

maturation than for classifying scar types.



2 Research Letter | Dermatol Pract Concept. 2025;15(4):5315

Case Presentation

A dermatoscopic evaluation was conducted on 68 scars  

(38 keloids, 20 hypertrophic scars, and 10 atrophic scars) at 

a dermatology outpatient clinic using polarized digital der-

matoscopy (Fotofinder©). Clinical and dermatoscopic find-

ings focused on vascular patterns, color, and the presence or 

absence of skin appendages.

In keloids (N=38), arborizing (branched) vessels were 

observed in 36.8% of cases, often associated with white or 

yellow structureless areas, indicating dense collagen nodules. 

Dotted vessels were less frequent. Mature keloids showed 

reduced vascularity, and in some cases, reappearance of 

trapped hair follicles, suggesting a transition to a regres-

sive phase.

In hypertrophic scars (N=20), thin linear vessels were the 

most common vascular pattern (50%), along with pinkish or 

reddish areas and parallel white bands, likely corresponding 

to compact collagen bundles.

Atrophic scars (N=10), often following intralesional 

corticosteroid therapy, exhibited prominent arborizing 

vessels (70%) and dermal thinning. These scars lacked 

curved or dotted vessels, helping differentiate them from  

proliferative-phase scars.

Statistical analysis revealed that vascular patterns (ar-

borizing, linear, dotted) were more strongly correlated 

with scar activity (e.g., inflammation, growth phase) than 

with scar subtype (Figure 1). Dermatoscopy also revealed 

the reappearance of pilosebaceous units during scar re-

gression, serving as a useful marker of scar maturation 

(Figure 2).

Dermatoscopic findings are summarized in Table 1.

Conclusions

Dermatoscopy is not reliable for distinguishing between ke-

loids and hypertrophic scars based solely on morphology. 

However, its true clinical utility lies in tracking scar dynam-

ics, such as vascular patterns, color changes, and follicular 

visibility, which reflect scar activity and maturation phase 

rather than classification.

Keloids in active growth show arborizing vessels and yel-

low-white structureless areas, while reduced vascularity and 

reappearance of follicles indicate regression. Hypertrophic 

Figure 1. Dermatoscopic patterns of curved, crossing and arborizing (A), linear (B) and dotted (C) vessels. 

Branched vessels increased significantly across scar types (P=0.005), especially in atrophic lesions. Linear 

and curved vessels showed progressive trends by scar type.



Research Letter | Dermatol Pract Concept. 2025;15(4):5315 3

Figure 2. (A) Macroscopic image showing a treated scar on the left 

thigh. (B) Under dermoscopy, hair follicles are identified extruding 

from non-hypertrophic scar tissue.  As scar thickness decreases, der-

matoscopy reveals the return of previously trapped hair follicles. 

Preserving these structures during treatment may support repigmen-

tation and enhance the scar’s cosmetic appearance.

Table 1. Dermatoscopic features of patients with atrophic, hypertrophic, and keloid Scars.

General Dermoscopic Findings

Finding Keloid Scars (N=38) Hypertrophic Scars (N=20) Atrophic Scars (N=9)

Erythematous areas 9 (23.7%) 3 (15.0%) 2 (22.2%)

Blood Vessels

Vascular Pattern Keloid Scars (N=38) Hypertrophic Scars (N=20) Atrophic Scars (N=9)

Arborizing (branched) vessels 14 (36.8%) 2 (10.0%) 6 (66.7%)

Linear vessels 11 (28.9%) 10 (50.0%) 1 (11.1%)

Dotted / comma-like
(curved) vessels

6 (15.8%) 0 (0.0%) 1 (11.1%)

Abbreviations: N: number of lesions; values in parentheses represent percentages. Statistical analysis: Fisher’s exact test showed a significant 
association between arboriform (branched) vessels and scar type (P=0.005). No statistically significant association was found for erythema-
tous areas (P=0.69), linear vessels (P=0.10), or dotted/comma-like (curved) vessels (P=0.13).

reminiscent of a distorted reticular vascular pattern, may be 

indicative of the emergence of the reticular vascular pattern of 

superficial plexus of normal skin in the maturation of a scar.

Dermatoscopy thus serves as a noninvasive, practical 

tool for monitoring scar progression and guiding treatment 

decisions, particularly timing and selection of adjunctive 

therapies like laser, cryotherapy, or energy-based devices.

Dermatoscopy enhances the clinical assessment of ab-

normal scars by identifying features linked to scar activity 

and evolution. Though it cannot differentiate scar types de-

finitively, it provides valuable insights into scar maturation 

and treatment response, supporting personalized and opti-

mized care.

References

1. Yoo MG, Kim IH. Keloids and hypertrophic scars: char-

acteristic vascular structures visualized by using dermos-

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ad.2014.26.5.603.

2. Abdallah M, Yassin M, Saber N. Dermoscopic features of keloid 

versus hypertrophic scar. Egypt J Hosp Med. 2018;70(4):621–4. 

DOI:10.12816/0043814.

3. Deng H, Li-Tsang CWP, Li J. Measuring vascularity of hypertro-

phic scars by dermoscopy: construct validity and predictive ability 

of scar thickness change. Skin Res Technol. 2020;26(3):369–75. 

DOI:10.1111/srt.12812.

4. de Oliveira, G. V., Sanford, A. P., Murphy, K. D., de Oliveira, H. M., 

Wilkins, J. P., Wu, X., Hawkins, H. K., Kitten, G., Chinkes, D. L.,  

Barrow, R. E., & Herndon, D. N. (2004). Growth hormone ef-

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scars show linear vessels that diminish with maturation 

along with increased follicular visibility. In atrophic scars, 

prominent arborizing vessels are typically shown due to  

steroid-induced dermal thinning, although arborizing vessels,