Hypertrophic Scars

The scars caused by increased tissue formation are called hypertrophic scars. This type of scar looks like a raised, firm mass of tissue, often red, inflamed, itchy, painful. There are many predisposing factors that influence the formation of these lesions; in fact they may be caused by a disturbance in the natural wound-healing process.



This tipical scar from acne is 1-2 millimeters in width, but some may be much larger and they remain limited to the traumatized area, regressing spontaneously within 12-24 months; however, regression may not necessarily be complete.

These scars commonly form on the face and trunk following severe cystic acne. These scars may also result from healed inflammatory lesions and usually stay within the confines of the precipitating trauma.
Prevention is key, but therapeutic treatment of these scars and keloids includes occlusive dressings, compression therapy, intralesional corticosteroid injections, excision, laser therapy.

The most standard treatment for these types of scars is the injection of steroids directly into the scar to help soften and flatten the scars, as well as the application of silicone sheets or gel. Steroid inhibits fibroblast growth, reducing the amount of collagen deposited into the scar. The most commonly used corticosteroid is triamcinolone acetonide (TAC) in concentrations of 10-40 mg/mL administered intralesionally with a 25- to 27-gauge needle at 4- to 6-week intervals.

Compression therapy involves pressure, which has long been known to have thinning effects on skin. Reduction in the cohesiveness of collagen fibers in pressure-treated scars has been demonstrated by electron microscopy.

A series of studies suggest that the pulsed-dye laser appears to be a very promising tool for treating these scars and keloids. It is hypothesized that by destroying the smallest blood vessels, localized reduction of oxygen may stimulate collagenase (which breaks down collagen).

In all cases, it is suggested to dicuss the options only with a board certified plastic surgeon to find a successful approach to combating these severe lesions.

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