Hypertrophic scars can be a source of frustration and discomfort for many individuals. These raised, thick scars develop when the body produces an excess of collagen during the healing process, resulting in a noticeable mark on the skin. Understanding the nature of hypertrophic scars and their impact on both physical appearance and emotional well-being is crucial for those seeking effective management strategies.
This article delves into the best practices and advice for managing hypertrophic scars. It explores the underlying causes and characteristics of these scars, discusses non-invasive treatment options available to patients, and examines medical interventions that can help improve scar appearance. By providing comprehensive insights into hypertrophic scar management, this guide aims to equip readers with the knowledge they need to make informed decisions about their scar treatment journey.
Understanding Hypertrophic Scars
Definition and Characteristics
Hypertrophic scars are raised, firm scars that develop due to excessive collagen deposition during the wound healing process. Unlike keloid scars, hypertrophic scars remain within the boundaries of the original wound and may regress over time. These scars are characterized by a thickened appearance and can be red, pruritic, and even painful. Hypertrophic scars tend to have collagen fibers arranged in a wavy, parallel pattern, which distinguishes them from the random, haphazard collagen orientation seen in keloids.
Causes and Risk Factors
Several factors contribute to the development of hypertrophic scars. Genetic predisposition plays a role in an individual’s susceptibility to excessive scarring. Hypertrophic scars often result from traumatic injuries such as burns, surgical incisions, or severe acne. The severity of the injury correlates with the likelihood of hypertrophic scar formation. Wound tension and movement also increase the risk of hypertrophic scarring, particularly in areas like the chest, shoulders, and knees. Prolonged inflammation during the healing process can trigger the overproduction of collagen, leading to raised scar tissue. Delayed wound healing or infection further elevates the chance of hypertrophic scar development. Age and ethnicity also influence hypertrophic scar formation, with children, young individuals, and those with darker skin tones being more prone to these scars.
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Difference from Keloid Scars
While hypertrophic scars and keloids share some similarities, there are distinct differences between the two. Hypertrophic scars remain confined to the original wound site, whereas keloids extend beyond the injury borders and continue to grow over time. Hypertrophic scars typically appear within weeks to months after the injury and may improve or regress spontaneously. In contrast, keloids can develop months or even years after the initial wound and rarely regress without intervention. Histologically, hypertrophic scars exhibit collagen fibers arranged in a wavy, parallel pattern, while keloids show thick, haphazard collagen bundles. Additionally, hypertrophic scars are more responsive to treatment compared to keloids, which tend to be more resistant and prone to recurrence after treatment.
Non-Invasive Treatment Options
Silicone Gel Sheets
Silicone gel sheets are a popular non-invasive treatment option for hypertrophic scars. These thin, flexible sheets are made of medical-grade silicone and can be applied directly to the scar. Silicone gel sheets work by creating a protective barrier over the scar, which helps to hydrate the skin and reduce collagen production. This, in turn, can help to flatten and soften hypertrophic scars over time. Silicone gel sheets are typically worn for 12 to 24 hours per day, and treatment can last for several months. They are easy to use, comfortable to wear, and can be cut to fit the size and shape of the scar. However, they may be visible under clothing and can be difficult to keep in place on certain areas of the body.
Pressure Therapy
Pressure therapy involves the use of compression garments or bandages to apply constant pressure to the hypertrophic scar. This pressure helps to flatten the scar and reduce its thickness by limiting blood flow to the area and decreasing collagen production. Pressure therapy is often used in combination with other treatments, such as silicone gel sheets, for optimal results. Compression garments are typically worn for 23 hours per day, with treatment lasting for several months to a year. While pressure therapy can be effective, it can also be uncomfortable and inconvenient for some patients. It is important to ensure that the compression garment fits properly and provides the appropriate amount of pressure to avoid complications such as skin irritation or impaired circulation.
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Topical Treatments
Several topical treatments are available for managing hypertrophic scars, including creams, gels, and ointments. These products often contain ingredients such as silicone, onion extract, or vitamin E, which can help to soften and flatten scars. Topical silicone gels, in particular, have been shown to be effective in reducing the size, redness, and itching associated with hypertrophic scars. They are easy to apply, dry quickly, and can be used on any skin type. However, they may need to be applied multiple times per day for several months to achieve optimal results. Other topical treatments, such as onion extract and vitamin E, have shown mixed results in clinical studies and may not be as effective as silicone-based products. It is important to consult with a healthcare provider before using any topical treatment to ensure that it is safe and appropriate for the individual’s specific scar type and skin condition.
Medical Interventions
Corticosteroid Injections
Corticosteroid injections are a mainstay treatment for hypertrophic scars. They work by breaking the bonds between collagen fibers, reducing the amount of scar tissue beneath the skin. Corticosteroids also have powerful anti-inflammatory properties, which can help reduce swelling, redness, itching, and tenderness associated with hypertrophic scars. Intralesional corticosteroid injections are usually administered in a dermatologist’s office after the scar has healed. If a patient has a history of hypertrophic scars and requires surgery, a doctor may inject steroids into the area before surgery begins to prevent a hypertrophic scar from forming or reduce its size. Surgeons may also administer an additional steroid injection during surgery. If a hypertrophic scar develops after surgery, dermatologists recommend getting steroid injections every four to six weeks, limiting the total number of injections to five. The procedure takes about 15 minutes, and often no anesthesia is required. In the hours after an injection, patients can break up scar tissue themselves and improve the effectiveness of the injections by gently massaging the scar. Side effects may include thinning or sunken skin at the injection site.
Cryotherapy
Cryotherapy, also known as cryosurgery, is a treatment modality that uses liquid nitrogen to freeze hypertrophic scars from the core outwards. This method can achieve effective results for reduction of scar formation and volume, and relieve patients’ subjective symptoms including pruritus and pain. Cryotherapy is often used in combination with other treatments, such as intralesional injection of drugs and postoperative radiotherapy, to shorten the treatment course and improve the therapeutic effect. The cryotherapy freezing process includes four phases: cooling rate, end temperature, hold time, and thawing rate. Each of these phases has an impact on the mechanism of injury on the frozen tissue. The tissue injury is induced by two synergistic arms – direct physical effects of cells freezing (intracellular ice formation) and the vascular stasis that develops in the tissue after thawing. It is postulated that another factor in the effect on the tissue following cryotherapy is the immunologic response, which is still under investigation. Repeated cryotherapy sessions can exhibit a beneficial effect on hypertrophic scars and additionally prevent relapses. However, multiple treatment sessions using cryotherapy may be required to flatten those scars.
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Laser Therapy
Laser therapy is an effective treatment for reducing redness and discoloration in hypertrophic scars, even if a scar healed a long time ago. The laser is a highly focused beam of light that dermatologists focus on scarred skin using a handheld device. The energy from the laser causes the blood vessels in scar tissue to shrink and eventually dissolve. It also causes a scar to lighten because the blood vessels are what cause redness and discoloration in a scar. Over several sessions, laser therapy can more closely match the color of a hypertrophic scar to the surrounding skin. Laser therapy reorganizes collagen deposition in the hypertrophic scars and improves their clinical aspect and symptoms. It is administered in a dermatologist’s office and causes few side effects. There may be slight bruising around the area of the scar; this fades in one or two days. Fractional carbon dioxide (CO2) laser therapy uses a high-energy beam of light to speed up the skin’s exfoliation and repair processes, and to remove scarred or discolored outer layers of skin. A dermatologist performs fractional CO2 laser therapy in their office using a small handheld device. After a local anesthetic is applied to the areas being treated, the device is passed over the skin. Depending on the size and texture of the hypertrophic scar, multiple sessions may be needed. Dermatologists typically recommend scheduling sessions every six to eight weeks.
Conclusion
Hypertrophic scar management has a significant impact on both physical appearance and emotional well-being. This article has explored various treatment options, from non-invasive methods like silicone gel sheets and pressure therapy to medical interventions such as corticosteroid injections and laser therapy. Each approach has its own benefits and potential drawbacks, highlighting the need for personalized treatment plans.
To wrap up, the key to successful hypertrophic scar management lies in early intervention and a multi-faceted approach. By combining different treatment methods and staying consistent with the chosen regimen, individuals can improve the appearance of their scars and boost their self-confidence. As research in this field continues to advance, new and more effective treatments may emerge, offering hope to those dealing with hypertrophic scars.