Hypertrophic Scars

Scars are always a cause of concern due to their unsightly appearance, especially if present in visible areas. They are abnormal overgrowth of cells and tissues under your skin that give a bulging appearance. These vary in shape, size, and color and can occur due to various causes. One such skin growth discussed in this article is "Hypertrophic Scar." A Hypertrophic scar is a thick, raised scar that is an abnormal response to wound healing. They commonly occur in thick and tight skin areas resulting from trauma, burns, or surgical incisions. Treatment for a hypertrophic scar depends on the size and may commonly include medication, freezing, injections, lasers, and surgery. 

Keep scrolling further as we help you explore this skin growth, its causes, symptoms, diagnosis, and treatment. 

What is a Hypertrophic Scar?

A hypertrophic scar is an abnormal skin growth characterized by a thick, raised scar resulting from an abnormal response to wound healing in which extra connective tissue forms within the original wound area. 

Where Do Hypertrophic Scars Commonly Occur?

Hypertrophic scars commonly appear in areas where skin is tight, such as the neck, shoulders, back, chest, and other joints. However, you may observe a hypertrophic scar in other areas of your body where you have had a skin injury or wound. 

What Causes a Hypertrophic Scar?

When your body sustains an injury, the wound goes through three phases of healing: inflammation, proliferation, and remodeling. In response to an injury, new collagen tissues are produced, and specific cells like fibroblasts, myofibroblasts, and certain signaling molecules are all involved. 

However, when there is abnormal and uncontrolled collagen production and repair response, with reduced elastin, the exact reason is not known, but it results in raised, stiff, and thick hypertrophic scars.

Several factors may increase your susceptibility to develop hypertrophic scars. These include:

• Genetic predisposition
• Second and third-degree burn wounds 
• Systemic inflammation
• Poor wound healing due to infection

What Are the Symptoms Associated With a Hypertrophic Scar?

A hypertrophic scar can be easily identified through the following signs and symptoms:

• Hard, stiff, raised, and thickened tissue over the wound site 
• Pinkish, reddish, or skin color discoloration near the wound site
• Commonly seen in the upper trunk of your body, back, chest, shoulders, and upper arm
• The scar usually develops one to two months after surgery
• You may experience mild itching, irritation, and tenderness around the scar 
• You may or may not experience any pain
• The scar on the skin covering your joints may limit your joint movements and flexibility 

How Are Hypertrophic Scars Diagnosed?

Hypertrophic scars can easily be diagnosed through their appearance and by examining the site of the scar. Additionally, diagnostic tests like biopsy may be required if the scar worsens. A tissue sample around the scar is extracted and sent to the laboratory for analysis. 

How Are Hypertrophic Scars Treated? 

Hypertrophic scars are not dangerous except for mild pain and itching and often do not require treatment. However, treatment may be required for cosmetic concerns if the scar develops in visible areas, negatively impacting one's appearance. 

The goal of hypertrophic scar treatment is to flatten, soften, and reduce the size of the scar, lighten the color, and ease any existing pain and itching of the scar. Usually, a dermatologist (a doctor specializing in the diagnosis and treatment of conditions related to the skin, hair, and nails) can help reduce hypertrophic scars through the following treatment options:

Medical Treatment

Corticosteroid Treatment 

• Corticosteroids are administered in the form of injections, which is considered the most effective treatment for hypertrophic scars. 
• Steroids ease inflammation and itching and shrink the scar.
• Your doctor may advise several steroid shots, each a few weeks apart. 

Laser Therapy

• Pulsed dye or long pulsed Nd: YAG lasers are commonly used to treat hypertrophic scars. 
• The lasers target the blood vessels and are removed to prevent abnormal scarring. 
• This method is particularly beneficial for scars causing limited joint movements. 

Bleomycin 

• Fluorouracil injections are injected and directed into the scar tissues. 
• This medicine flattens the scars and reduces inflammation and itching.
• These are usually combined with laser therapy or steroid injections.

Cryotherapy

• Here, extreme cold temperatures are used to freeze and slowly destroy scar tissue.
• This may also be combined with other treatment methods for more effective outcomes.

Surgery 

• Usually, surgery is considered when other treatment methods fail. 
• The scar tissue is surgically removed, and the tension lines are redirected. 

Home Treatment

Several self-help treatments can help reduce the hypertrophic scar, however, it is always best to consult your dermatologist before considering the following home remedies. 

Silicone Gel

•  Self-adhesive silicone sheets and ointments may cover the closed wound to prevent or reduce a scar.
• The sheets need to be worn every day for several months. 

Moist Dressing With Pressure

• Apply petroleum jelly in a moist adhesive flexible pad, and place it over the wound, fixing it with tape.   
• Apply pressure over the dressing to reduce the scar and improve the outcome.  

Onion Extract Creams 

• Topical gels of onion juice extract can reduce the hypertrophic scar size. 
• However, there is no proven evidence for it. 

What Are the Key Differences Between a Hypertrophic Scar And Keloid?

Here are the key differences between a hypertrophic scar and keloid that you need to know: 

Characteristics 

Hypertrophic Scar

Keloid 

Appearance 

Stays within the wound area

It may spread beyond the wound area and enlarge

Color 

Pink to red 

Red to purple 

Microscopic collagen arrangement 

The collagen fibers are parallel to the epidermis (superficial skin layer)

Fibers have a random, disorganized arrangement.

Success of treatment 

Easier to treat 

Hard to treat 

Resolving on its own

It may become less noticeable with time

Never resolve on their own without treatment

Bottom Line 

Scarring after an injury is a normal physiological process that usually fades or resolves over time. However, when there is excess and disorganized production of collagen fibers as an abnormal response to wound healing, hypertrophic scars develop near the wound site. The resulting growth is raised, red, thick and may be accompanied by pain and itching. Although they may resolve independently with time, you may require definite treatment for pain, discomfort, limited joint movement, and cosmetic reasons.