View source for Hypertrophic scar

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A '''hypertrophic scar''' is a [[cutaneous condition]] characterized by deposits of excessive amounts of [[collagen]] that create a raised [[scar]], but not to the degree observed with [[keloids]].<ref name="Bolognia">{{cite book | vauthors = Rapini RP, Bolognia JL, Jorizzo JL |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St. Louis |year=2007 |isbn=978-1-4160-2999-1 }}</ref> Like keloids, they form most often at the sites of [[Pimple|pimples]], [[body piercing]]s, [[Wound#Open wounds|cuts]] and [[Burn|burns]]. They often contain [[Nerve|nerves]] and [[Blood vessel|blood vessels]]. Hypertrophic scars generally develop after thermal or traumatic injury that involves the deep layers of the [[dermis]] and express high levels of [[TGF-β]].<ref>{{Cite journal |last1=Penn |first1=Jack W. |last2=Grobbelaar |first2=Adriaan O. |last3=Rolfe |first3=Kerstin J. |date=2012 |title=The role of the TGF-β family in wound healing, burns and scarring: a review |journal=International Journal of Burns and Trauma |volume=2 |issue=1 |pages=18–28 |issn=2160-2026 |pmc=3415964 |pmid=22928164}}</ref>

==Cause==
Mechanical [[Tension (physics)|tension]] on a [[wound]] has been identified as a leading cause of hypertrophic scar formation.{{refn|{{cite journal | vauthors = Yagmur C, Akaishi S, Ogawa R, Guneren E | title = Mechanical receptor-related mechanisms in scar management: a review and hypothesis | journal = Plastic and Reconstructive Surgery | volume = 126 | issue = 2 | pages = 426–434 | date = August 2010 | pmid = 20375759 | doi = 10.1097/PRS.0b013e3181df715d | s2cid = 23828914 }} cited in ''Acute Burn Care'' (2012) page&nbsp;332.<ref>{{cite book | vauthors = Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE |series=Handbook of Burns |volume=1 |title=Acute Burn Care |url=https://books.google.com/books?id=olshnFqCI0kC&pg=PA332|date=23 August 2012 |publisher=Springer Science & Business Media |isbn=978-3-7091-0348-7}}</ref>}}

When a normal wound heals, the body produces new collagen fibers at a rate that balances the breakdown of old collagen. Hypertrophic scars are thick, red to brown in coloration, and may be itchy or painful. They do not extend beyond the boundary of the original wound but may continue to rise or thicken for up to six months. Hypertrophic scars usually heal and fade over one to two years. Hypertrophic scars may cause distress due to their appearance or the intensity of itchiness. They can also restrict movement if located close to a joint.<ref>{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/keloids-and-hypertrophic-scars?search=hypertrophic%20scar&source=search_result&selectedTitle=1~64&usage_type=default&display_rank=1#H1282694807 |access-date=2024-05-29 |website=www.uptodate.com}}</ref>{{dubious|date=May 2019}}

Some people, such those with [[Ehlers–Danlos syndrome]], may have an inherited tendency to develop hypertrophic scarring.{{cn|date=July 2022}}

==Prevention ==
It is not possible to completely prevent hypertrophic scars, so those with a history of them should inform their doctor or surgeon if they need surgery. Pressure garment therapy is a commonly used approach to try to prevent hypertrophic scarring after a burn, but the effectiveness of this approach is unclear.<ref>{{Cite journal |last1=Harris |first1=Isobel M. |last2=Lee |first2=Kwang Chear |last3=Deeks |first3=Jonathan J. |last4=Moore |first4=David J. |last5=Moiemen |first5=Naiem S. |last6=Dretzke |first6=Janine |date=2024-01-08 |title=Pressure-garment therapy for preventing hypertrophic scarring after burn injury |journal=The Cochrane Database of Systematic Reviews |volume=1 |issue=1 |article-number=CD013530 |doi=10.1002/14651858.CD013530.pub2 |issn=1469-493X |pmc=10772976 |pmid=38189494}}</ref>

==Management==
Early hypertrophic scars should be treated by applying pressure or massage during the first 1.5–3 months.<ref name=":2">{{cite journal |vauthors=Juckett G, Hartman-Adams H |date=August 2009 |title=Management of keloids and hypertrophic scars |journal=American Family Physician |volume=80 |issue=3 |pages=253–260 |pmid=19621835}}</ref> If necessary, [[Silicone gel sheeting|silicone therapy]] should be applied later. Ongoing hypertrophy may be treated with corticosteroid injections.<ref name=":2" /> Surgical revision may be considered after 1 year.<ref>{{cite journal |vauthors=Cooper JS, Lee BT |date=December 2009 |title=Treatment of facial scarring: lasers, filler, and nonoperative techniques |journal=Facial Plastic Surgery |volume=25 |issue=5 |pages=311–315 |doi=10.1055/s-0029-1243079 |pmid=20024872 |s2cid=260136591}}</ref>

=== Silicone gel sheeting ===
[[Silicone gel sheeting]] is sometimes used to treat hypertrophic scars. Silicone gel sheets may improve the appearance of scars slightly compared with applying onion extract and may reduce pain compared with no treatment with silicone gel sheets or pressure garments.<ref name=":0">{{cite journal | vauthors = Jiang Q, Chen J, Tian F, Liu Z | title = Silicone gel sheeting for treating hypertrophic scars | journal = The Cochrane Database of Systematic Reviews | volume = 2021 | issue = 9 | article-number = CD013357 | date = September 2021 | pmid = 34564840 | pmc = 8464654 | doi = 10.1002/14651858.CD013357.pub2 | collaboration = Cochrane Wounds Group }}</ref> It is uncertain whether silicone gel sheets are more effective than other treatment methods.<ref name=":0" /> 

=== Laser therapy ===
[[Laser therapy]] is an approach that has been studied for treating hypertrophic scars.<ref name=":1" /> There is not enough evidence to determine if laser therapy is more effective than other treatments, or if laser therapy leads to more harm than benefit as compared to no treatment or different treatment.<ref name=":1">{{Cite journal |last1=Leszczynski |first1=Rafael |last2=da Silva |first2=Carolina AP |last3=Pinto |first3=Ana Carolina Pereira Nunes |last4=Kuczynski |first4=Uliana |last5=da Silva |first5=Edina MK |date=2022-09-26 |editor-last=Cochrane Wounds Group |title=Laser therapy for treating hypertrophic and keloid scars |journal=Cochrane Database of Systematic Reviews |language=en |volume=2022 |issue=9 |article-number=CD011642 |doi=10.1002/14651858.CD011642.pub2 |pmid=36161591 |pmc=9511989}}</ref>

=== Cryosurgery ===
[[Cryosurgery]], using extreme cold to remove dead tissue, may speed up the healing process of a hypertrophic scar to a flatter, paler appearance.<ref>{{cite journal | vauthors = Zouboulis CC, Blume U, Büttner P, Orfanos CE | title = Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series | journal = Archives of Dermatology | volume = 129 | issue = 9 | pages = 1146–1151 | date = September 1993 | pmid = 8363398 | doi = 10.1001/archderm.1993.01680300074011 }}</ref>{{Update needed|date=January 2024}}

== See also ==
* [[List of cutaneous conditions]]

== References ==
{{reflist|25em}}

{{Localized connective tissue diseases}}

[[Category:Dermal and subcutaneous growths]]
[[Category:Scarring]]