What is a hypertrophic scar?
Hypertrophic scars occur when too much connective tissue forms after a skin injury: Due to a disruption of the inflammatory phase or wound healing, the extracellular matrix – the connective tissue between the cells – proliferates excessively and is broken down more slowly at the same time. This results in a thick, bulging scar that rises above the surrounding skin.
Hypertrophic scars are particularly common after wound infections, burns or if the injury is located on a part of the body with greater skin tension, for example on the shoulder or chest.
Differences to keloids
Hypertrophic scars are similar to keloids – both are bulging scars that are raised above the surrounding skin. However, hypertrophic scars are significantly more common. They also differ from keloids in that they are
- are limited to the site of the injury
- sometimes regress spontaneously
- develop within the first six months after the injury, usually within the first six weeks
Hypertrophic scars: symptoms
Typically, a hypertrophic scar is reddish in color and rises bulging – as lumps or so-called plaques – above the surrounding skin. The scar often itches and after about two years of so-called maturing, it often looks like a small cord.
Hypertrophic scars: Treatment
There is currently no medical treatment method that reliably removes hypertrophic scars. However, attempts can be made to make them less noticeable. Which method is most promising depends on the individual case (e.g. size, location and age of the scar). It is often necessary to combine several treatment methods. The most important methods are
- Injections with glucocorticoids (cortisone): The doctor repeatedly injects cortisone directly into the scar tissue in order to reduce excessive scar growth. The treatment is often combined with icing.
- Icing (cryotherapy): The doctor uses liquid nitrogen for this. Either the scar tissue is only frozen for a short time and thus anaesthetized to make the subsequent painful injection of cortisone more bearable. Or the hypertrophic scar is frozen more intensively so that the excess tissue dies off.
- Pressure treatment: This can flatten a bulging scar.
- Laser: Using so-called ablative laser treatment, the doctor can remove a bulging scar in layers to flatten it. If a scar is accompanied by itching or severe redness, these symptoms can be eliminated with non-ablative laser treatment.
- Surgery: In some cases, hypertrophic scars can be excised.
Hypertrophic scar: prevention
Preventing a hypertrophic scar is better than trying to remove it. Everyone can do something about this themselves. The risk of developing a hypertrophic scar after a skin injury can be reduced if you keep the wound…
- protect it from the sun and extreme cold,
- expose it to as little tension and stretching as possible,
- rub it with onion extract (has an anti-inflammatory effect and is intended to prevent the excessive formation of fibroblasts, special connective tissue cells),
- massage regularly,
- rub with (marigold) ointment or olive oil to make them supple and, if necessary, soothe itchy scars with a cooling gel,
- if itching occurs, cover with a plaster to avoid scratching and irritating the hypertrophic scar through friction.
