Horizontal keloids are an irregular superficial spread of hypertrophic and depressed areas. These scars often have a mix of hyper- and hypopigmentation; usually a hypopigmented (lighter) central zone with hyperpigmented (darker) edges. The shape of the scar can be irregular or contractile (e.g., called ‘crab claw’ due to its appearance). A characteristic of these scars is central quiescence (where the centre of the scar appears flattened or mature). All types of keloid scar differ from hypertrophic scars because they can form outside the area of injury, they can be more raised and bumpy than hypertrophic scars.