Ever noticed a raised, firm scar that doesn’t quite fade over time? That’s a hypertrophic scar, a common result of injury, surgery or even acne. Unlike regular scars, these form when the skin produces too much collagen during healing, making them thicker and more noticeable.
While they’re harmless, some people prefer to reduce their appearance for cosmetic reasons.
In this article, we’ll cover everything you need to know about hypertrophic scars – what causes them, how they differ from other scars, their symptoms and the treatment options available to help manage them. You’ll also find prevention tips to minimise the risk of developing hypertrophic scars in the future.
What Are Hypertrophic Scars?
Hypertrophic scars are raised, thickened scars that form when the skin heals after an injury. Unlike keloid scars, hypertrophic scars develop within the boundaries of the original wound and do not extend into the surrounding skin. These scars are often red or pink and feature a firm, raised texture that can be visibly prominent and sometimes physically uncomfortable.
Common Characteristics of Hypertrophic Scars
- Raised texture. The scar is more elevated compared to the surrounding skin.
- Skin discolouration. Hypertrophic scars are often red or pink and transition to a darker hue over time. Some scars may have a brown, flesh-toned or white hue, depending on your skin tone.
- Confined to the original wound area. This type of scar does not spread into uninjured skin.
These scars form during the natural wound-healing process, which involves three phases:
- Inflammation
- Tissue formation
- Remodelling
Hypertrophic scars develop during the skin’s remodelling phase when excess collagen builds up, creating a raised, firm scar. While these scars may flatten over time, the process can take years, prompting many to seek treatment.
Hypertrophic Scars vs. Keloids
Both keloids and hypertrophic scars result from abnormal wound healing, but they differ in appearance, growth patterns, causes, treatments and common locations. Let’s discuss them one by one:
- Appearance. Hypertrophic scars are typically red or pink, raised and remain within the boundaries of the initial wound. On the other hand, keloids are often darker in colour, extend beyond the original wound boundaries and can take on a bulbous, irregular shape.
- Growth patterns. Hypertrophic scars usually form within weeks to months after an injury and may gradually reduce in size over time. Keloids, on the other hand, continue to grow and expand for several months or even years.
- Causes and risk factors. Both hypertrophic and keloid scars can result from skin injuries, such as burns, piercings, surgical incisions and severe acne. However, keloids are more likely to develop in individuals with darker skin tones and can have a genetic component.
- Treatment approaches. The treatment for both hypertrophic scars and keloid scars can include silicone sheets, steroid injections and pressure therapy. More severe cases might require surgical removal or laser therapy. However, it’s worth noting that keloid scars have a much higher recurrence rate, even after surgical removal.
- Common locations. Hypertrophic scars typically form at the site of an injury or incision. Although they can develop anywhere on the body, keloid scars tend to occur on the chest, back, shoulders and earlobes.
What Causes Hypertrophic Scars?
Hypertrophic scars arise from an overactive wound-healing process triggered by biological and environmental factors. Here’s a breakdown of the most common causes:
Biological Factors
- Excessive collagen production. The body sometimes produces an overabundance of collagen fibres during the healing process. They can accumulate at the wound site, forming a raised scar. The scars may vary in severity, depending on your genetics and wound location.
- Prolonged inflammatory response. If the inflammation phase of healing is unusually long, it can increase normal scar tissue formation. This extended response may be triggered by factors such as infection, repeated wound irritation or underlying health conditions that may slow the wound-healing process.
External Triggers
- High-tension wounds. Wounds that are stretched or tightly closed, often seen in surgical procedures, are more prone to scarring due to the increased pressure on the wound edges. This tension can disrupt the healing process and lead to more pronounced scars.
- Poor wound care. Inadequate care, such as failing to keep the wound clean or accidentally exposing it to harmful bacteria, can result in delayed healing. This can lead to thicker, more noticeable scars. Proper care, including cleaning, moisturising and covering the wound, can reduce hypertrophic scar formation.
- Type of injury. The nature of the injury you have plays a significant role in scarring. Some wounds tend to leave behind more visible scars. Naturally, deep cuts or lacerations that penetrate multiple skin layers can result in significant scarring.
Surgical incisions, often larger and requiring precision closure, may also leave noticeable scars. Burns can extensively damage the skin, leading to irregular scar tissue. Additionally, severe acne or piercings can cause localised inflammation and scarring, especially if not treated properly or if the skin heals poorly.
Genetic Predisposition
- If close family members have experienced hypertrophic scars, you may have an increased risk due to a possible genetic predisposition. Family history can significantly affect how your body heals and forms scars.
- People of African, Hispanic and Asian descent are more likely to develop prominent scars.
- Age and sex also influence hypertrophic scar formation, with adolescents and females showing a higher propensity for certain scars. This is likely due to hormonal fluctuations and skin composition during pivotal developmental periods.
Symptoms and Diagnosis
Understanding the process of scar formation and its contributing factors is essential for recognising how individual characteristics influence healing outcomes. By identifying the causes and symptoms of scarring and the methods used for diagnosis, we can better address concerns and explore effective treatment options tailored to each unique case.
Symptoms of Hypertrophic Scars
Hypertrophic scars are marked by
- Elevated, firm tissue with a thickened texture, standing out from the surrounding skin.
- Red or pink hue, with the discolouration becoming more noticeable over time.
- Pain, itchiness or tenderness. The itchiness can range from mild irritation to severe, persistent discomfort, while the pain may intensify when the scar is touched or stretched. This can significantly impact daily activities, particularly if the scar is in a sensitive or high-movement area.
In some cases, hypertrophic scars may also limit flexibility, especially when they form over joints or larger areas of skin. The hardened, tight scar tissue can restrict movement and contribute to ongoing discomfort.
How Hypertrophic Scars Are Diagnosed
Diagnosing hypertrophic scars involves a detailed clinical examination by a healthcare professional. The process starts with a thorough visual inspection of the scar to assess its size, shape, colour, texture and overall appearance.
Palpation is often performed to determine the scar’s firmness and elevation. Dermoscopy may be used for a more detailed assessment, allowing for a closer examination of vascular patterns and surface texture.
In addition to the clinical examination, it is essential to differentiate hypertrophic scars from other conditions, such as keloid formation, which extends beyond the original wound margins, or dermatofibromas, which are firm, benign nodules.
A comprehensive understanding of the scar’s cause, timing and associated symptoms like discomfort or itchiness is crucial in narrowing down the diagnosis.
Treatment Options for Hypertrophic Scars
There’s no one-size-fits-all approach to treating hypertrophic scars. Instead, treatment depends on the scar’s severity, age and location. Here are the most common options, ranging from non-invasive to surgical interventions.
Non-Surgical Treatments
- Laser therapy. Laser technologies like CO2, Pulsed Dye Laser (PDL), or Nd: YAG lasers are used to minimise the appearance of scars by targeting scar tissue and promoting skin regeneration.
- Injections. Corticosteroid injections help reduce inflammation and flatten hypertrophic scars.
- Cryotherapy. This treatment involves applying liquid nitrogen directly to the scar tissue to break it down and reduce its size over time.
- Microneedling. This technique uses fine needles to create micro-injuries in the skin, stimulating collagen production and enhancing the skin’s natural healing process to remodel scar tissue, making it an effective acne scar treatment.
Surgical Treatments
- Surgical excision. This involves the complete surgical removal of scar tissue, often followed by careful wound closure to encourage optimal healing and minimise the formation of new scars.
Prevention of Hypertrophic Scars
While some people are more prone to hypertrophic scar formation, there are steps you can take to reduce your risk. Here are some tips:
Proper Wound Care
Keep the wound area clean by washing it with mild soap and water. Make sure to avoid harsh soaps as they may irritate the skin. After cleaning, apply antibacterial ointment to prevent infection and aid recovery.
Cover the area with a sterile bandage or gauze to protect the skin and keep it moist. Change the dressing regularly, especially if it gets wet or dirty. Avoid picking at scabs or touching the area with unwashed hands, as this can delay healing or cause infection.
Try to keep pressure off the area and avoid activities that may irritate it. Contact a healthcare professional immediately if you notice redness, swelling or excessive pain.
Minimise Tension on Wounds
Keep wound edges supported by carefully closing them with sutures or sterile adhesive strips. This helps promote proper healing, reduces the risk of infection and ensures the wound stays securely closed during recovery.
Early Intervention
Using silicone sheets or gel shortly after the wound closes can help reduce the risk of excessive scar tissue growth. Silicone sheets keep the wound hydrated and provide gentle pressure to flatten the scar. These products are easy to apply and are often recommended by aesthetic practitioners and doctors for optimal healing.
Additionally, avoiding excessive sunlight is crucial, as UV rays can darken the pigmentation of scars, making them more noticeable over time. Wearing sunscreen or covering the area with clothing can provide extra protection to ensure the scar heals evenly and remains less visible.
Post-Treatment Care
- Hydrate the skin. Moisturising creams keep skin hydrated and aid in healing. Look for products with soothing ingredients like aloe vera or hyaluronic acid.
- Protect your skin with SPF. Regularly apply sunscreen with high SPF to prevent pigmentation changes and protect healing skin from UV rays. Sun protection reduces long-term discolouration.
- Regular check-ins. Schedule check-ins with your healthcare specialists to monitor your scar and adjust your care plan.
- Reduce stress. Stress slows healing. Try relaxation techniques like meditation or light exercise to support recovery.
- Avoid scratching. Don’t scratch or pick at the scabs, as this can cause irritation, delayed healing or infection. Use anti-itch creams if needed.
FAQs
What is the difference between hypertrophic and keloid scars?
While hypertrophic scars are raised but confined to the wound area, keloids extend beyond the wound and tend to grow over time.
How long do hypertrophic scars take to heal?
Most hypertrophic scars will begin to improve within 6 months to a year. Complete healing, however, can take several years.
Can hypertrophic scars be completely removed?
While they may not be completely removed, proper hypertrophic scar treatment can significantly reduce their appearance.
Conclusion
Managing hypertrophic scars requires both understanding and the right interventions. There are ways to address these abnormal scars, from non-invasive treatments like silicone sheets to surgical options. Early intervention is key, so take steps today to improve your skin’s appearance and health.
Remember, consulting a professional, such as Dr Justin Boey from the team at Sozo Aesthetic Clinic, can provide guidance tailored to your unique case.
If you’re concerned about your scars, we’re here to help—contact us today!
