All About Hypertrophic Scars

A hypertrophic scar is a thick raised scar that’s an abnormal response to wound healing. They more commonly occur in taut skin areas following skin trauma, burns or surgical incisions. Treatments include medication, freezing, injections, lasers and surgery.


What is a hypertrophic scar?

A hypertrophic scar is a thick raised scar. It’s an abnormal response to wound healing in which extra connective tissue forms within the original wound area. The result a raised scar.

Normally, a small wound to the top layer of your skin heals nicely. New skin forms as the wound heals. With deeper wounds (into the dermis layer and lower), your body responds by making collagen to repair the wound. Collagen is thicker than the rest of your skin. This thicker, less flexible tissue becomes a scar. Most scars are flat. However, sometimes your body makes extra collagen that results in a raised scar. This type of raised scar can be either a hypertrophic scar or a keloid.

What’s the difference between a hypertrophic scar and a keloid scar?

The key visible difference between hypertrophic and keloid scars is the degree of the spread of the scar around the original wound. With hypertrophic scars, the extra connective tissue that forms within the original wound stays within that area. With keloid scars, the extra connective tissue that forms extends beyond the original wound area. This and other differences between these two raised scars are shown in the table.

Hypertrophic Scars Versus Keloids
Hypertrophic scarsKeloids
Appearance around woundStays within wound areaExtends beyond wound area. Can grow very large.
ColorPink to redRed to purple
Where found on bodyMore common in taut skin areasTaut and less taut skin areas

Collagen arrangement (microscopically)

Collagen fibers are parallel to upper skin layer (epidermis)Collagen fibers have random, disorganized arrangement. More blood vessels are present.

Time to develop

Develops 1 to 2 months after injuryDevelops months to years after injury

Scar changing to cancer

Less frequently seenIncreased risk

Ease of treatment, success

Easier to treatHarder to treat, high return rate
Goes away on its ownMay become less noticeable with timeNever goes away without treatment

Where do hypertrophic scars commonly occur?

Hypertrophic scars are more common in areas of the body where your skin is taut, such as your back, chest, shoulders and upper arms, elbows and other joints. However, hypertrophic scars can occur anywhere on your skin where you’ve had a skin injury or wound.

Scar tissue can form from skin injury or wounds resulting from accidental trauma, inflammation, burns and surgical incisions. There are many other types of skin scars, each with their own appearance, causes and treatments.

Are there risk factors that increase the chance of developing a hypertrophic scar?

Factors that increase the risk of hypertrophic scarring include:

  • Burn wounds, especially second- and third-degree burns.
  • Systemic (whole body) inflammation.
  • Poor wound healing due to infection.
  • Genetics. Raised scarring, especially keloids, run in certain families.

Are hypertrophic scars dangerous?

No, they’re not dangerous or life-threatening. They’re mainly a cosmetic (physical appearance) issue. However, hypertrophic scars can cause pain or itching. Also, if they form over a joint, they can limit your movement so you may want to have them treated.


What causes hypertrophic scars?

Wounds go through three phases of healing – inflammation, proliferation and remodeling. Scar tissue forms during the remodeling phase. Specific types of cells such as fibroblasts and myofibroblasts and certain signaling molecules such as transforming growth factor-beta and tumor necrosis factor are all involved in wound healing and the creation of new tissue. In both hypertrophic scars and keloid scars, this repair response goes haywire. Although the reason is not fully understood, the result is the abnormal production of extra collagen and a decrease in elastin, which lead to these undesirable thick, raised stiff scars.

What are the signs and symptoms of a hypertrophic scar?

The signs and symptoms of a hypertrophic scar are easy to recognise. They include:

  • Hard or thickened raised tissue over your wound site.
  • Pink to red to purple skin colour over your wound site.
  • Scar appears most commonly on the upper trunk of your body – your back, chest, shoulders, upper arms – and skin that covers your joints.
  • Scar develops one to two months after injury.
  • Scar may cause irritation, itching, tenderness and/or pain.
  • Scar on your skin over a joint may limit your joint’s normal movement.


How are hypertrophic scars treated?

The goals of hypertrophic scar treatment are to flatten, soften, reduce the size, lighten the colour and ease any existing pain and itch of your scar. Your healthcare provider -- usually a dermatologist or plastic surgeon – may wait a few months or even up to year before treating your scar. This allows the scar enough time to fully heal and possibly reduce in size and flatten on its own.

Some common self-help treatments include:

  • ScarSil Silicone gel: Silicone Gel is used after the wound closes to prevent or reduce a raised scar. The self-adhesive sheets need to be worn every day, all day, usually for several months or longer. Scar Fx manages all aspects of the scar: reducing the size, redness, hardness and itchiness. 
  • Moist dressing with pressure garment: Apply petroleum jelly or a similar ointment to a non-adhesive flexible pad. Place over wound and affix to your skin with paper tape. Some studies have shown that applying pressure over the dressing, such as with an elastic wrap, spandex bandage or ACE bandage, reduces raised scars and improves outcomes.

Are hypertrophic scars caused by burns treated the same way as other skin injuries?

Hypertrophic scars that result from burn wounds are more difficult to treat. Superficial burn wounds usually heal without forming hypertrophic scars. Deep burn wounds are harder to treat. Many dermatologic and plastic surgeons treat these by removing the burned area and then using a skin graft.

Laser therapy is also often used to treat hypertrophic scars caused by burns. Laser therapy can improve the colour of the scar, the height of the scar, reduce skin tension on the scar, and improve pain and itchiness. You should also follow your provider’s recommendations about proper nutrition and vitamins to improve hypertrophic scar healing.

What are the complications of treating hypertrophic scars?

All treatments have possible side effects. Some may possibly worsen the scar. Scars may return, darken or overly lighten in colour. Be sure to ask your healthcare provider about the possible side effects of all treatment options being considered for your scar.

“A soft, gentle, non-sticky silicone gel designed to soften and flatten raised scars. It also helps relieve itchiness and discomfort associated with scarring.”

Rejuvaskin ScarSil® Silicone Scar Gel is a soft, gentle, non-sticky silicone gel designed to soften and flatten raised scars. It also helps relieve itchiness and discomfort associated with scarring.

Silicone ScarSil Gel actually softens and flattens raised scars. The silicone gel dries quickly forming a clear layer of silicone over your scar. This barrier limits collagen production to help minimize and prevent problem scarring. It’s best for scars less than two years old. ScarSil is effective for surgical scars, keloids, hypertrophic scars, facial scars, paediatric scars, and more.

Rejuvaskin ScarSil® Silicone Scar Gel is a topical silicone scar gel that enhances your body’s natural scar healing process. Silicone is the gold standard ingredient in scar management. It helps reduce collagen production to soften and flatten problem scars, even keloids and hypertrophic scars.

ScarSil dries quickly leaving a clear layer of silicone over your scar. It has no smell and doesn’t feel oily or sticky. You will forget ScarSil is even there! It’s so clear and pure, that we’ve heard from many it actually makes a great makeup primer.

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