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What is a Hypertrophic Scar? Diagnosis & Treatment of Thick Raised Scars

What is a Hypertrophic Scar? Diagnosis & Treatment of Thick Raised Scars

What is a Hypertrophic Scar – Diagnosis and Treatment of Thick Raised Scars Blog Image Coco Ruby Skin Care Melbourne

A Hypertrophic Scar is a thick raised scar that can occur in taut areas of your skin after physical trauma, burns, or surgical incisions. Normally, a small wound that occurs on the top layer of your skin develops into a flat scar. However, if you had deeper wounds, your body responds by producing collagen to repair damage to the area. Since collagen is thicker than the rest of your skin and the deeper the wound the more collagen the wound needs, a hypertrophic scar may form.

 

How Hypertrophic Scars are Diagnosed

A diagnosis of a hypertrophic scar is done by assessing the site of the scar. In general, the following are the characteristics of this type of scar;

  • Hard or thickened raised tissue over the wound site
  • The scar causes discomfort such as itching, irritation, pain, or tenderness.
  • The scar commonly appears in skin areas that cover your joints.
  • Pink to red to purple skin colour over the wound site
  • The scar may limit the natural movement of your joint.
  • The scar occurs one to two months after the injury.

 

What is the difference between a hypertrophic scar and a keloid scar?

  • With hypertrophic scars, the extra connective tissue that forms within the original wound stays within that area. However, this extra connective tissue can extend beyond the original wound area in keloid scars.
  • With regards to colour, hypertrophic scars are pink to red while keloid scars are red to purple.
  • Hypertrophic scars are usually located on taut skin areas while keloid scars are found on both taut and less taut skin areas.
  • The collagen fibers of hypertrophic scars are usually parallel to the upper skin layer while they have a random, disorganized arrangement in keloid scars.
  • Hypertrophic scars may take 1 to 2 months to develop while keloid scars may take months to years to form after injury.
  • Your risk of skin cancer is usually low if you have hypertrophic scars but this can increase with keloid scars.
  • With regard to treatment, hypertrophic scars are easier to treat and may become less noticeable over time. On the other hand, keloid scars never go away without the proper treatment.

Popular Treatments for Hypertrophic Scars

When it comes to treating these types of scars the aim is to flatten and soften the scar, as well as, reduce the size, lighten the colour, and alleviate discomforts (e.g. pain or itching). However, your dermatologist or plastic surgeon may recommend that you wait a few months or even a year before beginning to treat your scar. This gives enough time for the scar to fully heal and possibly reduce in size and flatten on its own. There are several ways to treat hypertrophic scars, including;

Corticosteroid injections

  • The injection of corticosteroids is the main treatment for thick raised scars.
  • Corticosteroids reduce the amount of scar tissue beneath your skin by breaking the bonds between collagen fibers.

Laser therapy

  • Hypertrophic scars are usually treated by long-pulsed lasers.
  • They work by stimulating the production of new skin cells to replace old and damaged skin cells.
  • Over time, healthy new tissue forms at the site, thus, reducing the colour of the scar and improving its texture.

Scar Revision Surgery 

  • This procedure removes the thick raised scar tissue permanently.
  • Scar surgery usually involves using an anaesthetic and cutting out the scar or redirecting the lines of tension on the scar.
  • While this method is effective, surgery is often the last resort because it can also result in scarring.
  • Surgery can also be done in conjunction with other scar treatment options for optimal results.

Silicone sheets and Tapes

  • They are used after wound closure to prevent or reduce hypertrophic scars. For best results, you need to wear the self-adhesive sheets every day (24 hours) for several months.
  • Silicone sheets improve the appearance of thick raised scars by; improving wound hydration and occlusion, reducing wound tension, decreasing blood flow to the scar site, and aiding in the alignment of structural proteins.

Compression Garments

  • These special garments are also worn 24 hours a day to help improve the appearance of hypertrophic scars.
  • The steady compressive force provided by the garment can stimulate the breakdown of excess collagen so that it can be reabsorbed by your body.
  • Over time, the scar flattens and becomes less noticeable.

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FAQs about Hypertrophic Scars

Do hypertrophic scars go away?

  • Hypertrophic scars are benign and do not cause any harm to your overall health. However, they can be a cosmetic concern because they do not go away.
  • While their size, shape, and height can be reduced over time, they will not completely disappear.
  • Hypertrophic scars can lighten as time passes by, making them less noticeable.

Do hypertrophic scars flatten on their own?

  • While hypertrophic scars do not completely disappear, they usually appear lighter and flatter over time, even without treatment.
  • It may take several months to years for the scars to become less noticeable.
  • For best results, you can try scar reduction treatments.

Why do scars become hypertrophic?

  • Normally, a small wound that occurs on the top layer of your skin develops into a flat scar. However, if you had deeper wounds, more collagen will be needed to repair the site of injury. Since collagen is thicker than the rest of your skin, a thick raised scar called hypertrophic scar may form.

How do you flatten a hypertrophic scar?

  • There are several other treatments that you can try to reduce the appearance of hypertrophic scars.
  • These include corticosteroid injections, laser therapy, bleomycin or 5-FU (fluorouracil) injections, cryotherapy, surgery, silicone sheets, and compression garments.
  • During your consultation, your healthcare provider will assess your scar and overall health to determine which treatments or combination of treatments will work best.

Can you cut off a hypertrophic scar?

  • When other treatment options have failed, surgery is recommended to remove the hypertrophic scar. However, your healthcare provider will advise you to wait at least a year before the procedure to allow the scar to fully heal.
  • During the procedure, a local anaesthetic will be injected into the target area. Once the anesthesia has taken effect, the practitioner will cut out the hypertrophic scar and will close the area using stitches. This method attempts to re-heal the injury while eliminating issues that may have contributed to the development of the scar in the first place, such as inflammation, infection, or tension.

Can massaging a scar make it worse?

  • Once your wound has healed, your healthcare provider will recommend that you start performing a gentle massage called gliding.
  • When performed correctly, it can help make your skin flexible, prevent itching, and reduce the appearance of the scar.
  • To perform scar massage:
    1. Place your fingers onto the scar.
    2. Move in gentle circular motions using your skin (not your fingers) to prevent skin irritation due to friction.
    3. Perform for a few minutes before applying moisturizer.

As the scar matures, you can increase the pressure of the massage. This helps soften the scars.

Why is my scar itchy and raised?

  • If you had deeper wounds, more collagen will be needed to repair the site of injury.
  • Since collagen is thicker than the rest of your skin, a thick raised scar called hypertrophic scar may form. In some cases, your scar can feel itchy. This is because scars are usually tight and not elastic like your skin.
  • Also, if you experience significant weight or skin changes, your scar may feel itchier.
  • This can also happen if you have dry skin.

How can I flatten my scars naturally?

  • There are natural ways to flatten your thick raised scars, including:
    • Using silicone sheets.
    • Applying shea butter or coconut to your skin.
    • Using compression garments.
    • Applying onion extract/gel and/or Apple Cider Vinegar to your skin.
    • Applying Aloe Vera gel to your skin.

Who is prone to hypertrophic scar?

  • You are at increased risk for hypertrophic scars if you have;
    • A family history of hypertrophic scarring.
    • Burn wounds, especially second- and third-degree burns.
    • Systemic (whole body) inflammation.
    • A history of poor wound healing.
    • Dark skin complexion.

How do you prevent hypertrophic scarring?

  • It may not be possible to avoid the formation of thick raised scars especially if it runs in your family. However, there are ways to lower the risk of hypertrophic scars. These include the following:
    • Use silicone gel or sheets on new scars.
    • Use compression garments.
    • Clean new piercings regularly.
    • Perform scar massage as your healthcare provider instructs.

When does hypertrophic scarring occur?

  • Six to eight weeks after injury, you will notice that thick raised scars called hypertrophic scars will begin to form at the site.
  • This will reach plateau in six months.
  • Unlike keloid scars, hypertrophic scars form in skin areas that cover your joints such as the elbows and knees.
  • When located over the joints, hypertrophic scars can affect the movement of the area.

Should you massage a hypertrophic scar?

  • Yes. – Once your wound has healed, your healthcare provider will recommend that you start performing a gentle massage called gliding.
  • When performed correctly, it can help make your skin flexible, prevent itching, and reduce the appearance of the scar.
  • As the scar matures, you can increase the pressure of the massage.
  • This helps soften the scars.

Are hypertrophic scars shiny?

  • Like keloid scars, hypertrophic scars are characterized by firm, rubbery lesions or shiny fibrous nodules.
  • They may appear as flesh-coloured to pink or even dark-red to brown.

What does a hypertrophic scar feel like?

  • Hypertrophic scars may feel like a hard lump or bump when touched.

Are hypertrophic scars itchy?

  • Yes. They can be itchy and painful because scars are usually tight and not elastic like your skin.
  • In case of significant weight or skin changes, your scar may feel itchier.
  • This can also happen if you have dry skin.

When will my scar flatten out?

  • The time it takes for scars to flatten out will depend on the extent of the injury and your healing ability.
  • Scars, especially thick raised scars, will take time to settle.
  • In general, the lumpiness, puckering, and thickening in the scar will require two to three months to diminish.
  • You will need to wait nine to twelve months for the redness and pigmentation to fade.
  • After twelve months, the scar should appear flat and pale.

Does bio oil help hypertrophic scars?

  • Bio-Oil is a cosmetic oil made from a combination of ingredients such as calendula, lavender, rosemary, and chamomile.
  • In a study of 80 volunteers with non-hypertrophic scars (40) or stretch marks (40) not older than 3 years, the application of bio oil for 8 weeks reduced the appearance of the scars and stretch marks. [1]

What are the 3 types of scars?

  • There are three types of scars:
    • Hypertrophic scars: With hypertrophic scars, the extra connective tissue that forms within the original wound stays within that area.
    • Keloid scars: The extra connective tissue can extend beyond the original wound area in keloid scars.
    • Contracture scars: These scars can tighten your skin and limit the movement of the affected area.

Is scar tissue a hard lump?

  • Yes. Extra scar tissue can grow and form a hard lump.
  • This is because scar tissue is composed of a tough, fibrous protein called collagen.

 

Medical References about Hypertrophic Scar minimisation

  1. Bielfeldt, S., Blaak, J., Staib, P., Simon, I., Wohlfart, R., Manger, C., & Wilhelm, K. P. (2018). Observer-blind randomized controlled study for improvement of scar and striae appearance. International journal of cosmetic science, 40(1), 81–86. https://doi.org/10.1111/ics.12438.