Hypertrophic Scar - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Hypertrophic scar develops when there is excess scar tissue leading to a thickened scar. 

Symptoms

A hypertrophic scar is a scar that is thicker than usual. Normally, as a wound heals, the scar is first red and bumpy but eventually becomes flat and skin-colored over several months. Similar to keloids, hypertrophic scars can form anywhere on the body, but they are more common in areas that have high tension, such as the chest, upper back, and shoulders. Sometimes, they can be itchy and painful. Unlike keloids where the edges of the scar grow beyond the borders of the initial wound, the edges of hypertrophic scars stay within the borders of the wound. 

 

Causes

Normal scar formation during wound healing requires a balance between collagen production and breakdown. Hypertrophic scars develop partially due to abnormally prolonged and intense inflammation during wound healing. This causes fibroblasts (the cells that work in scar formation) to overproduce collagen and form a hypertrophic scar. The excess collagen does not get broken down which results in the firmness and bumpiness of hypertrophic scars. Too much tension on the wound edges during wound healing can also lead to abnormally high collagen production to form hypertrophic scars. 

 

Treatments

  • Topical steroids 
  • Imiquimod cream
  • Pressure therapy: silicone bandage, pressure bandage, scar massage
  • Cryotherapy to freeze hypertrophic scar using liquid nitrogen
  • Injection of medications directly into the scar such as steroids or bleomycin 
  • Surgical scar revision to release tension of the scar
  • Microneedling
  • Various laser treatments such as the ablative fractionated CO2 laser