Hypertrophic scars
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Hypertrophic scars are a pathological form of skin healing in which there is excessive production of connective tissue at the injury site. They result from disrupted regulation of repair processes, leading to thickening, protrusion, and hardening of the scar while maintaining its boundaries within the original wound site. Unlike keloid scars, they do not tend to invade healthy tissues. This issue is significant not only from an aesthetic perspective but also functionally—hypertrophic scars can cause pain, itching, and restriction of movement of the skin and deeper tissues. Their treatment requires a multifaceted approach based on current medical knowledge and individual patient assessment.
Hypertrophic scars - what are they
A hypertrophic scar (Latin: cicatrix hypertrophica) results from excessive fibroblast activity during the proliferation phase of wound healing. This leads to increased synthesis of type III collagen, which over time does not properly remodel into type I collagen.
As a result, the scar becomes:
- thickened,
- hard,
- raised above the skin level,
- often red or bluish.
A characteristic feature is the limitation of the scar to the boundaries of the original skin injury, which is a key criterion distinguishing it from a keloid scar. Hypertrophic scars most commonly occur after surgical procedures, burns, and deep skin injuries.
Hypertrophic Scars – Causes
The development of hypertrophic scars is a multifactorial process. The most important causes include:
- excessive skin tension at the wound healing site,
- wound infection or prolonged inflammation,
- disturbances in the healing phases (particularly the proliferative phase),
- genetic predispositions,
- wound location (chest, shoulders, back, sternum area),
- age – more common in young individuals,
- lack of appropriate scar prophylaxis after surgical procedures.
It is worth emphasizing that even a properly treated wound can lead to the formation of a hypertrophic scar if the skin's repair mechanisms are hyperactive.
Hypertrophic scars – symptoms
Symptoms of hypertrophic scars include both morphological changes and subjective complaints:
- distinct protrusion of the scar,
- hardness and dense structure,
- redness or darker pigmentation of the skin,
- itching, burning, or pain,
- hypersensitivity to touch,
- restricted skin elasticity,
- in some cases, restricted movement if the scar runs over a joint.
Symptoms can persist for months or even years, with no tendency for spontaneous regression.
Hypertrophic scars – treatment
Treatment of hypertrophic scars should be initiated as early as possible, preferably during the active maturation phase of the scar. The standard procedure includes:
- conservative therapy,
- surgical treatment,
- scar physiotherapy.
The best results are achieved with combined therapy, tailored to the age of the scar, its location, and clinical symptoms. Local treatment alone often proves insufficient for mature and hard lesions.
Hypertrophic scars – how to remove
The complete "removal" of a hypertrophic scar in a medical sense is rarely possible, however, the realistic goal of therapy is to:
- flatten the scar,
- soften its structure,
- reduce redness,
- alleviate pain and itching,
- improve skin elasticity.
In clinical practice, the following are used:
- injection therapies (e.g., steroids, enzymes),
- fractional and vascular laser therapy,
- microneedling radiofrequency,
- mechanical and manual therapies,
- regenerative therapies stimulating collagen remodeling.
Patience and consistency are crucial – treating hypertrophic scars is a staged process.
Treatments for hypertrophic scars
In modern treatment of hypertrophic scars, procedures with documented clinical efficacy are used:
Most commonly used methods:
- Fractional laser – induces controlled micro-injuries, stimulating collagen remodeling,
- Vascular laser – reduces erythema and inflammatory activity of the scar,
- Microneedle radiofrequency – works on the deep layers of the skin, improving the elasticity and structure of the scar,
- Injection therapies – decrease fibroblast activity and collagen overproduction,
- Scar physiotherapy – tissue mobilization, improved blood circulation, and mobility,
- Regenerative therapies – support the skin's repair processes.
The selection of method depends on:
- The age of the scar,
- Its thickness and location,
- Clinical symptoms,
- Previous therapies.
Professional treatment of hypertrophic scars requires diagnosis, clinical experience, and an individual therapeutic plan, rather than a one-time procedure. It is a process where consistency and the right strategy determine the final outcome.