Hypertrophic Scar

Patient presenting with a scar like tissue, as seen in the picture below. Complains that it is very hard and big. In the beginning it was very small. Gradually, it increased in size and became itchy. Painful when touched hard or pressed. What can it be?

Doctor Answer: This appears to be a hypertrophied scar. You get them after some injury to the dermis (inner layer of the skin). Such lesions are usually excised out surgically. However, it’s worth trying a corn cap over it. Buy one from the market and apply.

What Is A Hypertrophic Scar?

It’s common to see a scar tissue form after burns, injuries or certain skin infection. Scar formation is a normal process and occurs as a part of healing of the wound.

However, amount of collagen getting deposited during scar formation sometimes exceeds what is required. This leads to heaping up of collagen in the dermis, below the skin surface.

Skin surface shows a raised, firm to hard area of excessive scarring. This excessively scarred area is called Hypertrophic scar.

Though scarring is both, normal and essential, for healing, excessive scarring may be problematic. It may cause discomfort or hinder movement, if over a joint.

Symptoms

Most common complain regarding them is their ugliness. Apart from this, hypertrophic scars may be:

• Itchy
• Painful, when pressed
• Give a burning sensation
• Cause hindrance in movements (when present over a joint area).
• Ugly to look at

This indicates that these scars have blood vessels and nerves inside them.

When Does A Scar Get Hypertrophied?

It is not clear why a scar gets hypertrophied, or what exactly are the signals that cause continued scarring beyond the required limit.

However, such scars have been seen to arise after:

• Traumas
• Burns
• Ear piercing
• Vaccination sites
• Surgerical sites
• After certain skin infections, as herpes etc.

In general, when a cut, whether surgical or caused by trauma, is not sharp edged, that is, the lesion is messy or blunt, there are chances that scarring is not precise and may over do its job.

It has also been seen that some people have a tendency for getting more of these scars, as in patients having Ehlers-Danlos syndrome.

Development Of The Scar

After the assault, may be injury or any other cause, the inner layer the skin called dermis starts producing collagen to fill in the deficiencies produced. This new collagen produced replaces the old worn out one, till needed.

If the signals to stop producing new collagen are not received, dermis keep producing it to from raised hypertrophic scars.

Are These Scars Cancerous?

No, they’re not. In fact, most of them would flatten down with time.

Are Keloid Same As Hypertrophied Scars?

Keloids are different.

A hypertrophied scar grows within the boundaries of the wound. It has nerves and blood vessels inside them. Also, they usually flatten with time, although very gradually.

On the other hand, keloids are formed by much excessive scarring than these scars. They are bigger, more firm and troublesome. They grow even beyond the wound boundaries and rarely flatten on their own.

How Are Hypertrophic Scars Treated?

• If its a small one, you may start applying any emollient over it on a daily basis, while gently giving it a massage. It may gradually soften with time.
• Silicone gels or patches may be used over them.
• Some require steroid injections, given once 6 weekly. This softens the growth inside and helps it melt away.
• More stubborn ones may require burning with cryosurgery or thermal ablation.