Hypertrophic Scars
Hypertrophic scars are raised, thickened scars that stay within the boundaries of the original wound. They often form after injuries, burns, or surgeries, particularly in areas with tension or frequent movement. Although not harmful, they can cause discomfort and may be cosmetically distressing. With a tailored treatment plan, Dr. Yoo helps patients manage hypertrophic scars and restore smoother, more comfortable skin.
What are hypertrophic scars?
A hypertrophic scar is an overgrowth of dense collagen that forms during wound healing. Unlike keloids, hypertrophic scars do not extend beyond the original wound area. They typically appear pink or red, feel firm or rubbery, and may cause itching or tenderness.
These scars often develop in areas with high skin tension, such as the chest, shoulders, upper arms, back, and joints. They usually form within 1 to 2 months after an injury and may continue to thicken for several months before stabilizing.
What causes hypertrophic scarring?
Hypertrophic scars result from an exaggerated healing response. During normal healing, fibroblasts create collagen to rebuild skin tissue. In hypertrophic scars, this collagen production is excessive and disorganized. Factors that increase risk include:
- Deep or second- to third-degree burns
- Surgical incisions
- Skin trauma or inflammation
- Infections or delayed wound healing
- Genetic predisposition
- Mechanical tension on the healing wound
How are hypertrophic scars different from keloids?
Although both are raised scars, hypertrophic scars are more localized and easier to treat. Key differences include:
- Boundary: Hypertrophic scars stay within the original injury site. Keloids grow beyond it.
- Timeline: Hypertrophic scars develop within 1 to 2 months. Keloids may appear much later.
- Ease of treatment: Hypertrophic scars respond better to treatment and may improve over time without intervention.
- Recurrence: Keloids are more likely to recur after treatment.
What are the treatment options?
Treatment is customized based on scar size, location, symptoms, and skin type. In many cases, a combination approach yields the best results.
- Corticosteroid injections: Steroids reduce inflammation and collagen production, helping to flatten and soften the scar. Multiple sessions are often needed.
- Laser therapy: Lasers like pulsed dye or fractional lasers can reduce redness, soften thickened tissue, and improve movement over joints.
- 5-Fluorouracil (5-FU) or bleomycin injections: These medications may be injected alone or in combination with steroids to reduce scar volume and symptoms.
- Cryotherapy: Liquid nitrogen freezes and destroys excess scar tissue. This is especially useful for smaller or resistant scars.
- Silicone gel sheets or ointments: Silicone helps hydrate the skin and regulate collagen, making scars flatter, softer, and less red when used consistently.
- Pressure therapy: Moist dressings with added pressure may help prevent hypertrophic scar formation after injury or surgery.
- Surgical revision: In select cases, surgical removal followed by adjunct treatments like radiation or steroid injections may be considered. However, surgery carries a risk of recurrence.
Who is at risk for hypertrophic scars?
You may be more likely to develop hypertrophic scars if you:
- Have a personal or family history of raised scarring
- Have darker skin types, which are more prone to abnormal scar formation
- Undergo surgery or trauma in high-tension areas like shoulders, chest, or joints
- Experience delayed or complicated wound healing
Safe options for all skin types
Dr. Yoo has expertise in managing scars on Asian skin and other skin of color, where pigmentary risks must be carefully managed. All treatments are chosen to minimize the risk of post-inflammatory hyperpigmentation or hypopigmentation.
When to consider treatment
Hypertrophic scars may improve with time, but treatment is recommended if they are:
- Painful or itchy
- Affecting movement
- Located in a highly visible area
- Causing self-consciousness or distress