What is a hypertrophic scar?

When there has been an injury to the skin, a scar can develop. Hypertrophic scars are scar tissue that is thick, raised, and wide.

While scars themselves are a common part of the healing process of a wound, hypertrophic scars form as a result of there being an abnormal response to skin injury or trauma.

During the healing process, some people can produce an over-abundance of collagen via myofibroblasts cells. This commonly occurs when a wound has become inflamed, infected, left on its own to heal with no stitches, or when the wound is over a joint, putting it under a lot of motion and tension. We frequently see this type of scarring with burn injuries, but they can form from acne, piercings, and cuts.

What is a keloid scar?

A keloid scar occurs when there is an excessive production of scar tissue beyond the margins of the initial injury.

In these instances, the scar will form a keloid, a hard smooth growth. A keloid can grow outside of the boundary of the original wounded area. While they can appear on any area of the body, the are more commonly seen on the shoulders, chest, earlobes and groin.

Hypertrophic scars, while similar to keloid scars, are much milder and they won’t grow past the original are of the injury. While these scars are not life-threatening or dangerous, they can be painful, and itchy or simply a cosmetic issue that people want to have minimized.

Hypertrophic scars vs. keloid scars

While hypertrophic and keloid scars can look the same, it’s important to know the difference, because each one requires different treatment.

Hypertrophic scars:

  • Rarely rise over 4 millimeters above the skin
  • Won’t grow beyond the boundaries of the initial wound
  • Are red or pink in color
  • Can develop anywhere on the body

Keloids:

  • Can be raised over 4 millimetres from the skins’ surface
  • Can grow beyond the boundaries of the original wound
  • Are pink to purple in color
  • Can evolve and grow over time
  • Can develop on the cheeks, earlobes, chest, shoulders, and above the sternum
  • Are itchy, tender and occasionally painful

What are the treatments for hypertrophic scars?

There are several treatments for this type of scarring, but you should get advice from your doctor first.

Applying Pressure – Pressure from a bandage or pressure garment (stretchy material as Lycra/Tubigrip) can weaken the scar tissue over time, greatly improving the appearance of the scar. This pressure should be applied day and night for up to months or even years.

Silicone – This is a non-invasive treatment that uses silicon in a sheet or gel form and is believed to help speed up the repairing and healing of scar tissue. This is applied after the wound has healed, directly to the skin. Depending on the severity of the scar, silicone is usually worn for 12 to 24 hours each day and dan be used for long as 6 months.

Steroids (Triamcinolone) – Steroid injections tend to be the first line of treatment for hypertrophic scarring. The steroid is injected directly into the scar itself. This treatment is done in intervals of four to six weeks and helps the scar to soften and flatten. There are also scar repairing creams that can be used, but you must seek advice from your doctor, as using steroid treatments for too long can weaken the normal skin tissue around the scar area.

What are the treatments for keloids?

Corticosteroid Injections -These are used to help reduce the inflammation of the keloid scar. Like steroid injections, it works to soften and flatten the scar tissue, giving it a smoother appearance over time.

5 fluorouracil – cytotoxic injection proven to reduce keloids

Silicone – Similar to treating a hypertrophic scar, using pressure or silicone gel pads after the injury will help quicken the healing process.

Surgery and Radiotherapy – These two treatments can be done individually or together. In some cases, when surgically removed, there is a chance that the scar can reoccur. This is why radiotherapy is used in conjunction after surgery. Radiotherapy alone sometimes helps shrink the keloids.

Frequently Asked Questions

Q. Will keloid scars continue to grow?

A. Yes, a keloid scar can continue to grow anywhere from weeks to years. They do eventually stop growing, but they won’t go away on their own. Once it has developed, it is permanent until it is either treated or removed.

Q. Will a hypertrophic scar flatten over time?

A. Yes, after it has had its initial period of growth, a hypertrophic scar can shrink or flatten over time.

Q. Can a treated keloid return?

A. Yes, in some instances a keloid can re-occur after treatment.

Q. Is there a way to prevent a keloid?

A. Treating a wound right away can lessen the chances of a keloid scar developing. Using treatments like silicon is one way to prevent the formation of a keloid scar.