Scars are a natural part of the body’s healing process after an injury, forming when the skin repairs itself by producing new collagen fibers. While many scars are flat and blend with the surrounding skin, some can become raised and more noticeable. One such type is the hypertrophic scar.
What Are Hypertrophic Scars?
Hypertrophic scars are thickened, raised scars that develop within the confines of the original wound boundary. They typically appear as red or pink, firm lesions that are elevated above the surrounding skin surface. These scars can also transition to a darker hue over time, such as brown, flesh-toned, or white, depending on skin tone.
These scars often form weeks to months after an injury, surgery, or even acne. While they may gradually reduce in size and flatten over time, this process can take years. Hypertrophic scars can be itchy, tender, or even painful, with discomfort potentially intensifying when the scar is touched or stretched.
The formation of hypertrophic scars occurs during the skin’s remodeling phase of wound healing. This involves an overproduction of collagen, a structural protein, leading to a raised, firm scar. Microscopically, the collagen fibers in hypertrophic scars have a wavy, regular pattern.
Distinguishing Hypertrophic Scars from Other Scars
Differentiating hypertrophic scars from other scar types, particularly keloid scars, is important due to their similar appearance and common confusion. Hypertrophic scars remain confined to the original wound’s boundaries. This characteristic is a primary distinguishing feature.
In contrast, keloid scars extend beyond the original wound site. Keloids can continue to grow and expand for several months or even years, unlike hypertrophic scars which stabilize and may flatten over time. Keloids are often darker in color, appearing red or purple, and can have a lumpy or ridged, rubbery texture.
Keloids are more common in individuals with darker skin tones and can occur anywhere on the body, though they are frequently found on the chest, shoulders, earlobes, and cheeks. While both scar types can be itchy or painful, keloids exhibit these symptoms for a longer duration. Hypertrophic scars, on the other hand, can affect individuals of all races and ages.
Common Causes of Hypertrophic Scars
Hypertrophic scars arise from an abnormal healing process where the body produces excess collagen at the site of a skin injury. This overproduction can be triggered by various types of trauma or conditions. Common causes include burns, surgical incisions, deep cuts, and severe acne.
Other factors contributing to their development include tension on the wound and inflammation during healing. Wounds in areas subject to constant movement or tension, such as the chest, shoulders, elbows, back, and knees, are more prone to these scars. Prolonged inflammatory responses, delayed healing, or infections can also increase the likelihood of their formation.
Genetic predisposition can also influence an individual’s susceptibility to developing these scars. Younger individuals, particularly those between 10 and 30 years old, have a higher predisposition due to increased collagen production.
Treatment Approaches for Hypertrophic Scars
Treatment for hypertrophic scars aims to flatten, soften, reduce their size, lighten their color, and alleviate pain or itching. Healthcare providers, often dermatologists or plastic surgeons, may recommend waiting several months to a year before initiating treatment to allow the scar to mature and potentially improve on its own.
Non-invasive and minimally invasive options are used. Silicone sheets or gels are used, as they help flatten and soften scars by hydrating the tissue and regulating collagen production. Compression therapy, involving specialized garments or bandages, can also reduce inflammation and flatten raised scars.
Corticosteroid injections, such as triamcinolone acetonide, are a widely used minimally invasive treatment. These injections directly into the scar tissue can reduce inflammation and inhibit collagen production. Laser therapy can target scar tissue to reduce redness, improve texture, and stimulate new skin growth.