A significant association exists between metabolic syndrome (MetS) and an increased risk of excessive scarring, highlighting the potential of MetS management in preventing scarring, according to a study.
“Specifically, increased waist circumference, hypertension, hypertriglyceridemia, and low high-density lipoprotein cholesterol (HDL-C) were identified as key metabolic components linked to this risk,” the investigators said.
Data from 466,625 UK Biobank participants were used in this study. Multivariable Cox regression was conducted to explore the relationship between MetS and excessive scarring. Stratified analyses were also conducted based on age, gender, and ethnicity.
A total of 714 new cases of excessive scarring were recorded over a median follow-up of 13.65 years. After adjusting for confounders, patients with MetS were found to have a 28-percent higher risk of excessive scarring (hazard ratio [HR], 1.28, 95 percent confidence interval [CI], 1.08‒1.52). [J Am Acad Dermatol 2026;95:700-707]
Specific factors, including increased waist circumference (HR, 1.42, 95 percent CI, 1.15‒1.76), hypertension (HR, 1.30, 95 percent CI, 1.08‒1.55), high triglycerides (HR, 1.25, 95 percent CI, 1.06‒1.46), and low HDL-C (HR, 1.27, 95 percent CI, 1.08‒1.49), were associated with an elevated risk. This risk also increased with the number of MetS components present.
These results persisted in sensitivity analyses using alternative MetS definitions. In stratified analyses, more robust associations were observed in males, individuals aged <60 years, and White participants.
“Collectively, these findings suggest that metabolic dysregulation may play a role in the pathogenesis of excessive scarring and highlight it as a potential area for future therapeutic investigation,” the investigators said.
Keloids
A retrospective study in the US found that patients with keloids had a higher prevalence of comorbidities, including obesity, hypertension, hyperlipidaemia, and diabetes, than those without keloids. [Int J Dermatol 2024;63:e163-e170]
“Our findings are consistent with this prior study regarding obesity, hypertension, and hyperlipidaemia; however, we did not replicate the observed association with diabetes,” the investigators said. “This discrepancy may be attributed to limitations inherent in the cross-sectional design of the aforementioned study.”
Previous studies have also reported the association between keloids and hypertension. Some keloid patients with hypertension had keloid regression following treatment with enalapril. Furthermore, an earlier study that also utilized the UK Biobank found a link between hypertension and excessive scarring, consistent with the current findings. [Lancet 1996;347:465; JAMA Dermatol 2023;159:172-181]
Likewise, hyperlipidaemia correlated with the development of keloids. Previous studies reported lipid metabolism disorders as a key pathological factor in keloid development and progression. [Lipids Health Dis 2013;12:60; Int Wound J 2024;21:e14733]
In a hyperlipidaemic state, the levels of lipid substances (eg, triglycerides, cholesterol, and arachidonic acid) in the serum rise. This stimulates the body to produce large amounts of proinflammatory mediators such as PGE2, LTB4, and TNF-α, which produce a chronic inflammatory microenvironment, according to the investigators.
On the other hand, low intake of omega-3 fatty acids prevents the body from synthesizing anti-inflammatory agents like resolvins and protectins, leading to worse inflammation response, they added.
“In summary, hyperlipidaemia significantly increases susceptibility to keloids by inducing chronic inflammation, activating fibrotic signalling pathways, and remodelling the skin microenvironment, making it an important contributing factor,” the investigators said.