A hypertrophic scar is a

cutaneous condition A skin condition, also known as cutaneous condition, is any medical condition that affects the integumentary system—the organ system that encloses the body and includes skin, nails, and related muscle and glands. The major function of this sy ...

characterized by deposits of excessive amounts of

collagen Collagen () is the main structural protein in the extracellular matrix found in the body's various connective tissues. As the main component of connective tissue, it is the most abundant protein in mammals, making up from 25% to 35% of the whole ...

which gives rise to a raised

scar A scar (or scar tissue) is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a na ...

, but not to the degree observed with

keloids Keloid, also known as keloid disorder and keloidal scar, is the formation of a type of scar which, depending on its maturity, is composed mainly of either type III (early) or type I (late) collagen. It is a result of an overgrowth of granulation ...

. Like keloids, they form most often at the sites of pimples,

body piercing Body piercing, which is a form of body modification, is the practice of puncturing or cutting a part of the human body, creating an opening in which jewelry may be worn, or where an implant could be inserted. The word ''piercing'' can refer to ...

s, cuts and burns. They often contain nerves and blood vessels. They generally develop after thermal or traumatic injury that involves the deep layers of the

dermis The dermis or corium is a layer of skin between the epidermis (with which it makes up the cutis) and subcutaneous tissues, that primarily consists of dense irregular connective tissue and cushions the body from stress and strain. It is divided i ...

and express high levels of

TGF-β Transforming growth factor beta (TGF-β) is a multifunctional cytokine belonging to the transforming growth factor superfamily that includes three different mammalian isoforms (TGF-β 1 to 3, HGNC symbols TGFB1, TGFB2, TGFB3) and many other sign ...

Cause

Mechanical

tension Tension may refer to: Science * Psychological stress * Tension (physics), a force related to the stretching of an object (the opposite of compression) * Tension (geology), a stress which stretches rocks in two opposite directions * Voltage or el ...

on a wound has been identified as a leading cause for hypertrophic scar formation. When a normal wound heals, the body produces new collagen fibers at a rate which balances the breakdown of old collagen. Hypertrophic scars are red and thick and may be itchy or painful. They do not extend beyond the boundary of the original wound, but may continue to thicken for up to six months. Hypertrophic scars usually improve over one or two years, but may cause distress due to their appearance or the intensity of the itching; they can also restrict movement if they are located close to a joint. Some people have an inherited tendency to hypertrophic scarring, for example, those with Ehlers–Danlos syndrome.

Prevention

It is not possible to completely prevent hypertrophic scars, so those with a history of them should inform their doctor or surgeon if they need surgery.

Management

A 2021

systematic review A systematic review is a Literature review, scholarly synthesis of the evidence on a clearly presented topic using critical methods to identify, define and assess research on the topic. A systematic review extracts and interprets data from publ ...

brought together evidence from different studies that investigated using silicone gel sheeting to treat hypertrophic scars. 13 studies with a total of 468 participants were reviewed in total. Many different treatments were included but it was uncertain whether silicone gel sheets were more effective than most of these. Silicone gel sheets may improve the appearance of scars slightly compared with applying onion extract, and may reduce pain compared with no treatment with silicone gel sheets or pressure garments. A 2022

included multiple studies on laser therapy for treating hypertrophic scars. There was not enough evidence for the review authors to determine if laser therapy was more effective than other treatments. They were also unable to conclude if laser therapy leads to more harm than benefits compared with no treatment or different kinds of treatment. Scar therapies, such as

cryosurgery Cryosurgery is the use of extreme cold in surgery to destroy abnormal or diseased tissue; thus, it is the surgical application of cryoablation. The term comes from the Greek words cryo (κρύο) ("icy cold") and surgery (''cheirourgiki'' – χ� ...

, may speed up the healing process from a hypertrophic scar to a flatter, paler one. Early hypertrophic scars should be treated with applied pressure and massage in the first 1.5–3 months. If necessary, silicone therapy should be applied later. Ongoing hypertrophy may be treated with corticosteroids injections. Surgical revision may be considered after 1 year.

References

{{Localized connective tissue diseases Dermal and subcutaneous growths

Cause

Prevention

Management

See also

References