What is a Hypertrophic Scar?
A hypertrophic scar occurs when excessive amounts of collagen is deposited at the site of an injury or lesion on the skin. The raised scar should not be confused with keloid scars. These types of scars are often encountered in areas of the skin where there was acne or at the site of a piercing. Cutting one’s skin or suffering from thermal or chemical burns can also lead to hypertrophic scarring. The important thing to remember is that this particular type of scar is innervated and vascularized and that it goes until the deep layers of the dermis.
The moment a lesion of any kind occurs on the skin, it is the job of the collagen fibers to repair that lesion. In some cases, the repair process is exaggerated and an excessive amount of collagen fibers is deposited in the region. The hypertrophic scar will have a red color and a varied thickness, being often described by the patient as red and painful. The scar will always remain within the initial lesion but as the repair process develops, it may thicken. The appearance of the hypertrophic scars improves with the passing of time, but it always presents a cosmetic concern and it brings discomfort to the patient because of the constant itchiness. Plus, there are certain cases in which the hypertrophic scar might limit the mobility of a joint.
What is the difference between a keloid and a hypertrophic scar?
Both types of scars appear after a lesion on the skin caused by different injuries, traumas, piercings, pimples etc. However, the difference is that, in the case of the keloid scar, the excessive deposits in the skin consist of various fibrous tissues, as opposed to the hypertrophic scar, in which the excessive deposits actually are collagen fibers. In case of the keloid scar, the excessive fibrous tissue will breach the actual site of the wound, it will not regress on its own and, even after excision, it will present a high risk of recurrence.
On the other hand, the hypertrophic scar is characterized by its red color, the constant itchiness and the fact that it does not go beyond the original wound. This type of scar can regress on its own (at least partially) and it will not re-appear after surgical excision.
Hypertrophic Scar Treatment
These are the most common courses of treatment for the hypertrophic scar:
- Intralesional corticosteroid injections – these can have a long-lasting effect, allowing the aspect of the scar to be improved
- Cryosurgery – using liquid nitrogen, the hypertrophic scar is practically frozen. However, the best results are when this particular type of surgery is combined with the cortisone injections that were mentioned above
- Laser treatments – these are recommended as well for the treatment of the hypertrophic scar, showing promising results whereas the aesthetic aspect of the scar is concerned
- Surgical excision is recommended in the case of large scars
- Electron-beam radiation
- Orthovoltage radiation
- Silicone pads and creams are recommended for symptoms of itchiness, inflammation and redness
- Occlusive dressings
- Compression therapy
- Interferon therapy
- Retinoids are also recommended but only for short periods of time as they can have serious consequences on a person’s general health
- Immunomodulators – imiquimod cream is recommended for hypertrophic scars
- Injections with botulinum toxin
- Vitamin E and vitamin A
- Vascular endothelial growth factor inhibitors
- Phototherapy (UV-A, narrow band UV-B)
The removal of the hypertrophic scar is made using basic soft tissue handling techniques, with special attention given to the closing process, so as there is minimal tension involved. The doctor will most likely use the buried sutures, in order to obtain what is known as a layered closure and also because they guarantee the lowest level of tension that is possible. After the surgery, the doctor will use pressure dressing or garments, to relieve the inflammation and promote lymph drainage. Decreased recurrence rates have been encountered in cases when the removal was associated with radiotherapy treatments, IFN injections or therapy with corticosteroids.
One variant of removal is through Z-plasty. This is a method in which the scar tissue is removed by small incisions that are made around the hypertrophic scar site. The benefits of this procedure are: size reduction, increased mobility and better blending with the rest of the healthy skin. Pulsed dye laser has also been used for the removal of the hypertrophic scars but it requires several sessions and it seems that it does not guarantee removal but rather an improvement of the symptoms. It seems that the usage of the pulsed dye laser reduced or even eliminates upsetting symptoms, such as the burning sensation or the constant itchiness experienced by different patients.
Pictures of Hypertrophic Scar
Collection of photos, pictures of Hypertrophic Scar…