Hypertrophic Scarring

Overview

A hypertrophic scar is a raised, firm, and often red or pink scar that develops when the body makes too much collagen while a wound heals. Unlike a keloid, a hypertrophic scar stays within the boundaries of the original injury and does not spread into surrounding healthy skin.

These scars commonly appear after burns, surgery, cuts, piercings, or acne, especially in areas under tension such as the chest, shoulders, and across joints. While they can be uncomfortable or cosmetically bothersome, hypertrophic scars are not dangerous and often soften and flatten on their own over time. A range of treatments can speed improvement when needed.

Symptoms

Hypertrophic scars have several recognizable features:

• A raised, thickened scar that follows the line of the original wound
• Red, pink, or darker coloring, which may fade over time
• Firm or rubbery texture
• Itching, tenderness, or a burning sensation, especially early on
• Tightness or reduced movement if the scar crosses a joint

Unlike keloids, hypertrophic scars do not grow beyond the edges of the wound and tend to improve gradually rather than continue enlarging.

Causes

Hypertrophic scars form when the normal wound-healing process produces excess collagen and the scar tissue builds up. Contributing factors include:

• Wound tension: Scars across areas of movement or stretching are more likely to thicken.
• Burns: Deep or large burns commonly heal with hypertrophic scarring.
• Infection or delayed healing of a wound.
• Surgery, cuts, piercings, or acne that injure the deeper skin.

Risk Factors

• Wounds in high-tension areas such as the chest, shoulders, and over joints
• Burns, especially deep or extensive ones
• A personal or family tendency toward thick scarring
• Younger age
• Wound infection or slow healing

Diagnosis

Doctors usually diagnose hypertrophic scars by examining the skin and reviewing the history of the wound. The key clue is a raised scar that remains within the borders of the original injury.

• Visual examination of the scar's size, color, and texture.
• Distinguishing from keloids, which extend beyond the wound edges.

A skin biopsy is rarely needed and is reserved for uncertain cases.

Treatment

Many hypertrophic scars improve over time, but treatment can speed flattening and ease symptoms. Options include:

• Silicone gel or sheets: Applied to the scar for several weeks to months to soften and flatten it.
• Pressure therapy: Compression garments, often used after burns.
• Corticosteroid injections: To reduce thickness, itching, and redness.
• Laser therapy: To improve color and texture.
• Massage and moisturization to keep the scar supple.
• Surgical revision: Reserved for stubborn scars, sometimes combined with other treatments to lower the chance of recurrence.

The best approach depends on the scar's size, location, and how much it bothers you.

Prevention

• Keep wounds clean and follow proper wound-care instructions to support healthy healing
• Reduce tension on healing wounds, for example with surgical taping techniques when advised
• Use silicone gel or sheets on healing wounds prone to thick scarring
• Protect new scars from the sun, which can darken them
• Avoid picking at wounds or scabs

When to See a Doctor

See a doctor or dermatologist if a scar is:

• Growing, very raised, or increasingly itchy or painful
• Limiting movement of a joint
• Bothering you cosmetically
• Showing signs of infection, such as increasing redness, warmth, swelling, or drainage

Early treatment of a thickening scar often gives better results.

Related Topics

Frequently Asked Questions

References

1. American Academy of Dermatology Association. Scars: Diagnosis and treatment.
2. Mayo Clinic. Scars.
3. MedlinePlus, U.S. National Library of Medicine. Scars.
4. British Association of Dermatologists. Hypertrophic and keloid scars.