Hypertrophic Scar: Causes, Signs & Symptoms, Risk Factors and Treatment Options

What is a Hypertrophic Scar?

A Hypertrophic scars, also known as a keloid scar, is a thick, raised scar that forms when the body overproduces collagen during the skin healing process after an injury. This leads to excess scar tissue building up at the wound site. It remain confined to the original wound area, while keloid scars may grow quite large and rise up well beyond the borders of the original wound.

Causes
Any break in the skin can potentially cause a hypertrophic scar to form. Some common causes include:

- Surgical incisions - It often form after surgery to remove skin lesions, repair cuts or lacerations, or after cosmetic procedures. The deeper and more complex the incision, the higher the risk.

- Burns - Scarring after thermal, chemical or radiation burns is very common due to the extensive damage caused to skin tissues. Scars are more likely if the burn required skin grafting.

- Acne or chickenpox - Pockmarks or pits in the skin left after acne or chickenpox lesions heal can develop into hypertrophic scars in some individuals.

- Traumatic injuries - Deep cuts, puncture wounds, bites or other skin injuries carrying a risk of excess scarring. Factors like wound location, size and if it was sutured all influence scar outcome.

Signs and Symptoms of Hypertrophic Scarring
Hypertrophic scars differ from normal, mature scars in several respects:

- Raised scar above the level of the surrounding skin. They feel hard, thick and ropey rather than flat.

- Often red in color though may lighten or darken over time. The scar edges may be wider than the original wound.

- Itchy, tight or tender scar. The scar tissue often causes a burning or tight sensation.

- Scar mobility is reduced due to thickened, inelastic collagen formation. Movement of the scarred area is restricted.

- Develop within 1-2 months post-injury or surgery. Scars continue to evolve for up to 2 years but most change occurs in the first year.

Risk Factors for Hypertrophic Scarring
Certain factors increase one's tendency to develop hypertrophic scars, including:

- Genetics - Some ethnicities like African, Asian and Hispanic backgrounds carry higher risks. First-degree relatives of those with past excessive scarring issues are also at risk.

- Youth - Children and teenagers naturally produce more collagen than adults, heightening scar hypertrophy possibilities.

- Wound location - Areas like the shoulders, back and thighs are prone to form problematic scars versus low-risk sites like the forehead or scalp.

- Scar immaturity - Scars that are still actively remodelling when subjected to repetitive motion or friction are susceptible to thickening.

- Malnutrition - Deficiencies of vitamins A and C involved in collagen synthesis can result in suboptimal scar formation.

- Smoking - Smokers have significantly poorer wound healing, raising the chances of disordered scarring.

Treatment Options
Early and consistent treatment generally yields the best scar improvement outcomes. Management approaches used singly or in combination include:

Silicone Gel Sheeting
- Leading non-invasive therapy - silicone gel sheets enhance collagen remodeling, soften scars and reduce their prominence. Must be worn for 12-23 hours daily for 4-12 months.

Corticosteroid Injections
- Weak glucocorticoid steroids regulate scar collagen deposition when injected directly into the scar every 4-6 weeks, up to 5 treatments.

Pressure Therapy
- Compression garments or tape taping helps reform scar texture by passive pressure on the scar to mimic skin tension. Best for new scars.

Intralesional Cryotherapy
- Liquid nitrogen sprayed onto scar freezes and destroys some collagen fibers and promoting better healing. Usually given monthly, up to 6-12 treatments.

Scar Revision Surgery
- Indicated for very raised or wide scars limiting function. Dermabrasion, laser resurfacing or scar excision smoothes the scar and skin grafting may be used to achieve optimal results. Followed by adjunct scar management modalities.

Prevention of Hypertrophic Scarring
While not always possible to prevent, some actions may help reduce scar hypertrophy risks:

- Gentle scar massage to increase mobility and drainage, once completely healed.

- Phototherapy with lasers or broadband UV light may help flatten some darker, mature scars already formed.

- Moisturize daily to keep scar supple without irritating it.

- Wear protective, well-padded clothing over new scars subject to trauma.

- Manage wounds meticulously and avoid additional injuries until scars fully mature in 6-12 months.

In summary, through early intervention, a multidisciplinary approach, compliance with treatment and prevention methods, significant reduction though not complete avoidance of hypertrophic scars can be achieved. Patients need to understand it as a natural healing response to be guided for optimal outcomes.

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Ravina Pandya, Content Writer, has a strong foothold in the market research industry. She specializes in writing well-researched articles from different industries, including food and beverages, information and technology, healthcare, chemical and materials, etc. (https://www.linkedin.com/in/ravina-pandya-1a3984191)

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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it