Hypertrophic Scar Treatment Options

Hypertrophic Scars – An Overview

A hypertrophic scar results from an abnormal wound-healing process in response to skin trauma. When the skin is burnt or injured (due to a wound or surgical incision), the skin’s natural healing process starts. Under normal circumstances, the skin repair process stops when the skin is fully healed. However, for some individuals, the skin cells produce too much collagen in response to an injury or skin trauma. As a result, the skin healing process doesn’t stop when the wound is healed. Instead, the body cells, known as myofibroblasts, continue to produce collagen, resulting in a raised, wide scar at the injury site.

Typically, the overproduction of collagen is an autoimmune response, but it can also occur if the wound or injury site is inflamed or infected. While these scars are a common complication of surgical incisions or burn injuries, they can also be formed after simple procedures like piercings. Moreover, even acne can grow into hypertrophic scars.

Hypertrophic scars are more commonly found in body areas where the skin is stretched, such as shoulders, upper arms, back, and chest, and on certain joints like elbows and knees. Even so, hypertrophic scars can appear anywhere on the body and are a typical response to injury, skin trauma, or surgical incision.

They also aren’t a life-threatening condition; however, they are beyond a cosmetic concern. They can be discomforting, itchy, and even painful. Many individuals who develop hypertrophic scars seek treatment to reduce the appearance of the scar and manage its undesirable symptoms, which include itching and pain.

Let’s learn more about the treatment and management of hypertrophic scars.

Hypertrophic Scar vs. Keloid Scar

A hypertrophic scar stays within the boundary of the original wound and often improves with time, while a keloid grows beyond the wound’s edges and rarely shrinks without treatment. Both result from excess collagen during healing, but keloids extend past the injury site and are more likely to persist or recur, especially after surgical removal.

Hypertrophic Scar Revision Treatments

There are several treatment options that can help manage hypertrophic scars. The objectives of these treatments include the following: 

• Soften, flatten, or reduce the size/appearance of the hypertrophic scar,
• Lighten the scar color, and
• Ease existing itching and pain at the site of the scar.

Typically, a cosmetic dermatologist or a plastic surgeon provides treatment for hypertrophic scars. Some of the most common treatment options for hypertrophic scars include the following.

Corticosteroid Injections

One of the most common and effective hypertrophic scar injection options is the use of corticosteroid injections (steroid injections). They are injected at the site of the scar tissue via an injection and can help break the bond between collagen fibers. As a result, the injectable drug softens the scar tissue beneath the skin and eases symptoms such as itching and pain.

For certain hypertrophic scars, a single shot is enough to ease undesirable symptoms like itching and pain and flatten the appearance of the scar. However, for specific hypertrophic scars, several shots may be required, each given a few weeks or months apart.

Bleomycin Injections

One of the other injectable treatment options for hypertrophic scars is the Bleomycin injection. The medication is also directly injected into the scar tissue. However, it works differently from corticosteroid injections.

Bleomycin injections suppress collagen production in the scar tissue, which helps slow down scar growth. Moreover, it helps reduce symptoms such as itching, discomfort, and pain.

These injections aren’t often given as a stand-alone treatment. Instead, they are combined with other medications like corticosteroid injections or other treatment options like laser therapy to flatten the scar and alleviate the painful symptoms.

Laser Therapy

Laser therapy (laser scar treatment) is also one of the most effective treatment options for hypertrophic scars. The laser is targeted towards blood vessels, which provide blood to the scar.

Typically, an untreated scar continues to get blood supply (and essential nutrients along with it) and grows. However, the lasers target blood vessels within the scar, which constricts the blood vessels and inhibits scar proliferation.

Moreover, laser treatment also helps reduce itching, pain, and hardness of the scar and lighten its color.

The treatment option is particularly effective for hypertrophic scars that haven’t responded well to other treatments.

Cryotherapy

Another popular treatment option for hypertrophic scars is the use of liquid nitrogen to flatten the scar tissue. Medically known as cryotherapy, the procedure involves the use of extreme cold, liquified nitrogen for freezing the scar tissue. Over time, the extreme temperature aids in destroying the scar tissue. This results in the flattening of the elevated tissue.

Like with Bleomycin injections, cryotherapy isn’t often used as a stand-alone treatment but is combined with different types of treatments to diminish the scar and alleviate the associated symptoms.

Surgical Removal of the Scar

Sometimes, other treatment options for hypertrophic scars fail to produce the desired results. In such instances, surgical removal of the scar is often recommended.

However, surgery should never be used as a stand-alone treatment option, as an impaired healing process may result in abnormal skin growth and an even larger hypertrophic scar.

Surgical scar removal produces the best results when combined with laser therapy. Moreover, it can also be used alongside radiation therapy for added benefits. Multiple low to moderate doses of radiation are given after the surgical removal of the scar, which can help shrink the scar tissue and reduce the recurrence risk.

Over-the-Counter Raised Scar Removal Options

There are various over-the-counter scar management options for people wondering how to flatten hypertrophic scars. Silicone gel or silicone sheets for scars are among the better-supported at-home treatment options, with multiple studies and reviews indicating they can slightly improve scar texture, color, and height, and may reduce pain compared with no treatment or pressure garments. 

Evidence for other home remedies (oils, creams, onion extract) is more limited, so silicone-based products are usually the preferred option for those treating raised scars at home. That being said, there’s no guarantee that any of the above options will work as you’d like. 

Key Takeaways

If your skin has a tendency to develop hypertrophic scars following a skin trauma or surgical incision, it’s best to consult a healthcare provider and discuss possible treatment options.

An experienced dermatologist can recommend the best possible treatment based on the location and size of your scar while considering all other factors, such as your age and previous instances of wound-healing. And if your scar hasn’t responded to injections, laser, or at-home care, ask your dermatologist about surgical scar revision, which can be combined with other treatments to improve results.

Remember, hypertrophic scars aren’t just a cosmetic concern. They can be painful and severely affect an individual’s quality of life. Therefore, it’s critical to consult an expert healthcare provider who can provide the best possible solution for your concerns. 

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