A scar can form as the wound heals when body tissue is damaged by a physical injury.
Scars may be red and raised at the beginning. The scar will become flatter and more pale as the injury heals over time.
A hypertrophic scar may result from tension around the wound. These are red and thick and last for a couple of years. We look at ways in which these scars can be treated, avoided, and minimized in this article.
If there is a lot of tension around a healing wound, hypertrophic scars happen. These scars are deep and raised, and the color is mostly red. They may remain like this for several years.
The result of an imbalance of collagen at the site of the wound is hypertrophic scars.
A hypertrophic scar’s characteristics include:
- Restricting movement, because the skin is not as flexible anymore
- Forming within the limits of the initial wound
- creating healing tissue that is thicker than usual
- being red and raised to start with but becoming flatter and paler over time
Hypertrophic scars are not to be confused with keloids, although they do have some similar features.
Keloids are reddish nodules which develop in order to heal a wound, as gristle-like connective tissue forms. Even after the wound has healed, a keloid continues to form, which results in a large mound of scar tissue.
Keloids affect only about 10 percent of people, estimated by the American Osteopathic College of Dermatology, while hypertrophic scars are more common.
Men and women from any racial group are affected equally by hypertrophic scars, although people aged between 10 and 30 years are more likely to be affected. It is believed that this is because young people have more elasticity in their skin and produce a higher rate of collagen.
Both hypertrophic and keloid scars can be painful and itchy. Usually they happen on the upper body, upper arms, shoulders, neck, or earlobes.
Hypertrophic scars usually settle on their own over time, although certain therapies may aid the process.
Since the early 1980s, silicone gel sheeting has been used in the treatment of hypertrophic scars.
At the very early stage of scar formation, this treatment is best used. For 23 out of 24 hours a day for 6 to 12 months, pads are put directly on the scar.
It is assumed that under the pad, the silicone makes up a reservoir of water that helps keep the scar hydrated. This increased hydration will assist in preventing the development of a worse hypertrophic scar.
This therapy works by applying compression to the wound. It is often used for burn treatment. When wounds take longer than 10 to 14 days to heal or after skin grafting, pressure dressings are particularly useful.
The use of high pressure, elastic dressings has been claimed to minimize the formation of hypertrophic scars by between 60 and 85 percent.
Pressure dressings function by restricting the wound to blood, oxygen, and nutrients, which decreases the rate of production of collagen.
The first-line treatment for keloids is cortisone or steroid injections. They may be used for the treatment of hypertrophic scars as well. Every few weeks, the injections are repeated.
After cortisone injections, between 50 and 100 percent of people notice an improvement and sometimes hypertrophic scars can disappear completely after this procedure.
There is also, however, a 9 to 50 percent recurrence rate. Darkening of the skin of the treated and surrounding area may include side effects.
For the first 3 to 6 months, hypertrophic scars may increase in size and then begin to regress. Surgery is not normally required for this purpose.
However, if the hypertrophic scars are impeding movement due to being at a joint, or they are causing excessive tension in the underlying tissue, then surgery may be an option.
Other treatments for hypertrophic scars include:
- Cryotherapy: This combination of liquid nitrogen with steroid injections has been shown to be effective for keloids but is not often used for hypertrophic scars.
- Creams and oils: Options include onion extract, heparin gel, and bleomycin.
- Superficial X-ray treatment: This treatment may be used soon after surgery but is uncommon.
- Laser treatment: Laser treatment can improve skin texture and color but does not always flatten a hypertrophic scar.
Research indicates that hypertrophic scars, with between 30 and 91 percent of recorded hypertrophic scars after a burn, are normal after burn injuries.
Many other injuries, including accidental trauma or piercings, as well as surgery, may also be accompanied by hypertrophic scars.
As the occurrence rate after surgery is about 40 to 94 percent, avoiding any unnecessary skin surgery can reduce the risk of having a hypertrophic scar.
The surgeon will aim to ensure that surgical lines are, wherever possible, along the skin tension lines when skin surgery is inevitable. It can also help to avoid scarring by using silicone gels and sheets for several months after an operation.
After inflammation from a skin disease, like acne and chickenpox, hypertrophic scars will occasionally occur. Prompt and effective rehabilitation for these illnesses can help prevent the development of hypertrophic scars.
Hypertrophic scars are benign and not detrimental to the general health of an individual. They do not turn into cancer of the skin.
Between 6 months and 3 years after it first emerges, a hypertrophic scar can always regress fully.
Around 75% of people with hypertrophic scars said that their main concern was how the scar looked, rather than how it affected their health.
It is important to remember that there can also be side effects from multiple procedures, so if the scar is not harmful, no action may be the best action.
However, if a person is concerned about the existence of a hypertrophic scar, they should contact a physician to discuss their options for treatment.
Depending on the location, size, thickness, and spread of the hypertrophic scar, treatment will be determined.
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- Oakley, A. (2014, September). Keloid and hypertrophic scars (LINK)
- Rabello, F. B., Souza, C. D., & Farina Júnior, J. A. F. (2014, August). Update on hypertrophic scar treatment. Clinics, 69(8), 565-573 (LINK)
- Scars – hypertrophic and keloid. (2017, January 27) (LINK)
- Types of scars. (2014, April 9)(LINK)
- Medicalnewstoday – Tips for treating and reducing hypertrophic scars (LINK)