Hypertrophic scars

Hypertrophic scars are scars that become thicker, raised and firmer than normal during the healing process.

Unlike keloids, hypertrophic scars remain within the limits of the original wound and, over time, many of them improve spontaneously.

They do not represent a health risk, although they can produce aesthetic discomfort, itching, pain or limit movement when they are located over a joint.

During normal healing, the body produces collagen to repair the skin.

In hypertrophic scars there is an excessive production of collagen for a certain time, which causes the scar to rise.

A single cause is not known, but several factors are involved.

Hypertrophic scars are more frequent when there are:

• Deep wounds.
• Burns.
• Surgeries with tension on the skin.
• Significant traumas.
• Wound infection.
• Slow healing.
• Young people.
• Areas subjected to continuous movement.

The most usual locations are:

• Shoulders.
• Back.
• Chest.
• Neck.
• Abdomen.
• Knees.
• Elbows.
• Surgical areas.

Over the joints they can partially hinder mobility.

It is important to distinguish both lesions.

Hypertrophic scar. It remains within the original wound, can improve over the years, responds better to treatment and has a lower tendency to reappear.

Keloid. It grows beyond the limits of the wound, can continue growing for years, presents a higher risk of recurrence and has an important genetic component.

In addition to the visible relief, some people present itching, sensitivity, pain, redness, stiffness and a sensation of tightness.

On other occasions they only represent an aesthetic problem.

The diagnosis is clinical. During the examination, the doctor will assess the size, the thickness, the colour, the time of evolution, the location, the symptoms and the history of abnormal healing.

Complementary tests are generally not necessary.

The treatment depends on the age, the size and the symptoms of the scar.

Silicone sheets or gel. They constitute one of the first-choice treatments. They help decrease the thickness, reduce the redness, improve the texture and decrease the itching. They are usually used for several months.

Corticosteroid injections. Intralesional injections make it possible to progressively reduce the volume, the hardness, the itching and the pain. Several sessions are frequently necessary.

Vascular laser. It can improve the redness and some associated symptoms.

Fractional laser. It favours collagen remodelling and can improve the thickness, the elasticity, the texture and the overall appearance of the scar.

Pressotherapy and compression therapy. Especially useful in some extensive scars, above all after burns.

Surgery. In certain cases it may be necessary. However, when there is a high risk of recurrence, it is usually combined with other treatments to decrease the possibility of the scar growing again.

With the appropriate treatment, a decrease in thickness, a lesser relief, a better colour, greater elasticity, a decrease in itching and pain and a better aesthetic appearance are usually achieved.

The improvement is usually progressive.

Yes, especially in people with a history of hypertrophic scarring. The preventive measures include the adequate closure of the wound, avoiding excessive tension on the scar, treating infections early, using silicone when indicated and protecting the scar from the sun through photoprotection.

It is advisable to consult when the scar increases in thickness, produces intense pain or itching, limits movement, continues growing several months after the injury or there are doubts about whether it is a keloid.

• Myth: All raised scars are keloids. Fact: No. Most correspond to hypertrophic scars.
• Myth: Hypertrophic scars never improve. Fact: Many decrease in thickness over time, even without treatment.
• Myth: Creams completely eliminate these scars. Fact: Treatments help improve them, but rarely make them disappear completely.
• Myth: Surgery is always the best option. Fact: In many cases medical treatments are sufficient and, when operating, it is usually necessary to associate other therapies to reduce the risk of recurrence.
• Myth: Exposing the scar to the sun helps it disappear. Fact: Sun exposure can favour permanent changes of colour. It is advisable to use sun protection during the healing process.

• Hypertrophic scars remain within the limits of the original wound.
• They are produced by a temporary excess of collagen during healing.
• They must be differentiated from keloids, since their evolution and treatment are different.
• Silicone and corticosteroid injections constitute first-line treatments.
• Early treatment usually offers better results.
• Sun protection and medical follow-up favour higher-quality healing.