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HYPERTROPHIC SCARS

INDICATION – BRIEF

Hypertrophic scars are thick, raised, and often red scars that develop due to an exaggerated healing response to injury or surgery, typically manifesting within weeks of the inciting event. Clinical factors causing these include surgical wounds, burns, infections, and physical trauma. Non-clinical factors involve genetics (certain individuals may be predisposed to such scarring), ethnicity (some groups are more susceptible), age (younger individuals have a higher tendency), and wound location on the body (areas with tight or frequently moved skin are at higher risk). Treatment varies from pressure therapy and silicone gel sheeting to invasive interventions, and it’s crucial to consult a specialist for personalized management strategies.

INDICATION – DEFINITION

Hypertrophic scars are thick, raised, often red scars that occur due to the body’s exaggerated response to injury or surgery. They usually develop within weeks after the injury and can continue to thicken for up to six months. Unlike keloids, another type of raised scar, hypertrophic scars don’t grow beyond the boundaries of the original wound.

Clinical factors

  1. Surgical Wounds: Surgery, particularly where tension on the wound edges is high, or the incision is across lines of least skin tension, can result in hypertrophic scars.
  2. Burns: Significant thermal injuries often result in hypertrophic scarring due to the extensive damage and healing that occurs.
  3. Infections: Infections that delay wound healing, cause increased inflammation, or lead to more tissue destruction can result in hypertrophic scars.
  4. Trauma: Physical injuries that break the skin, such as lacerations, abrasions, or punctures, can result in hypertrophic scarring.

Non-clinical factors

  1. Genetics: Certain individuals may have a genetic predisposition to hypertrophic scarring, where the skin tends to heal with thicker scars.
  2. Ethnicity: Some ethnic groups, such as African, Asian, and Hispanic individuals, are known to be more susceptible to hypertrophic scars and keloids.
  3. Age: Younger individuals have a higher tendency to form hypertrophic scars due to the skin’s higher collagen production rate compared to older individuals.
  4. Location on Body: Wounds on parts of the body where the skin is tight or frequently moved (like the chest, shoulders, earlobes, and upper arms) are more likely to form hypertrophic scars.

Management typically involves pressure therapy, silicone gel sheeting, intralesional corticosteroids, and at times more invasive interventions like surgery or laser therapy. However, the most effective treatment may vary based on the individual’s health status, scar characteristics, and personal preferences. Hence, it’s essential to have a comprehensive consultation with a dermatologist or a plastic surgeon to decide on the best management strategy.

SYMPTOMS AND DIAGNOSIS

Symptoms

Symptoms of Hypertrophic Scars

Hypertrophic scars are characterized by:

  1. Raised or elevated appearance, often being thicker in the center
  2. Red or pink color, which can lighten over time
  3. Often confined within the boundaries of the initial wound
  4. Itching or discomfort, especially in the early stages of formation
  5. Reduced flexibility in the scarred area, which might impact range of motion if the scar is over a joint.

The severity and extent of these symptoms can vary greatly depending on factors like the location of the scar, the size and depth of the original wound, the person’s age, and their individual healing process.

Diagnosis

Diagnosis of Hypertrophic Scars

The diagnosis of hypertrophic scars is typically clinical, based on a thorough physical examination of the skin and the scar, and a detailed medical history. A dermatologist will assess the appearance, texture, and location of the scar, and will inquire about the timeline of scar development, history of the wound, and any symptoms like itching or pain.

In some cases, the dermatologist might order a skin biopsy – a procedure where a small piece of scar tissue is removed and examined under a microscope – to distinguish a hypertrophic scar from a keloid or to rule out other conditions. However, this is typically not the first line of approach as it is invasive and could potentially exacerbate the scarring.

Remember, it’s essential to share all relevant information with your dermatologist, including how the scar has changed over time and any discomfort you might be experiencing. This will allow them to make an accurate diagnosis and develop an effective treatment plan.

Prognosis and Impact

Prognosis

Prognosis of Hypertrophic Scars

Hypertrophic scars, unlike keloids, generally improve over time without treatment. They start developing within weeks after the injury and may continue to thicken for months. After this period, they often gradually become flatter and paler over the course of one to two years. However, the extent and rate of this natural improvement can vary significantly among individuals. Some scars may remain visibly raised and discolored even after this time.

Despite the physical changes, hypertrophic scars may not completely return to the appearance or texture of normal skin. In some cases, further medical treatment may be necessary to improve the scar’s appearance or to alleviate associated symptoms such as itching or restricted mobility.

Impact

Impact of Hypertrophic Scars

Hypertrophic scars can have both physical and psychological impacts on an individual.

Physically, hypertrophic scars can lead to itching, pain, or discomfort. If the scar is located over a joint, it can restrict movement, affecting the individual’s functionality and daily activities. Moreover, they can lead to skin tightness and changes in skin texture.

Psychologically, the appearance of hypertrophic scars can significantly impact a person’s self-esteem and body image, particularly if the scars are in visible areas. This can lead to social anxiety, emotional distress, and, in severe cases, depression.

It’s important to remember that treatment options are available to reduce the physical appearance and relieve the discomfort of hypertrophic scars.

Treatment Options

Treatment Options for Hypertrophic Scars

There are several treatment options for hypertrophic scars, ranging from non-invasive therapies to surgical procedures. The most effective treatment will depend on the individual, the characteristics of the scar, and the impact it has on their quality of life:

  1. Silicone Sheets and Gels: This is a non-invasive option that involves applying a sheet or gel of silicone on the scar. This method can help to reduce the scar’s size and improve its color and texture.
  2. Pressure Therapy: This involves applying constant pressure to the scar using special bandages or tight-fitting garments. This is commonly used for large burn scars but can be used for other scars as well.
  3. Intralesional Injections: Steroids, like triamcinolone, are often injected directly into the scar to help flatten and soften it. Other medications, such as 5-fluorouracil or bleomycin, can also be used.
  4. Laser Therapy: Lasers can improve the color and surface texture of the scar. Some types of lasers can also penetrate deeper into the skin to remodel the scar tissue.
  5. Surgery: In some cases, the scar may be surgically removed and the wound closed carefully to minimize the chance of a new hypertrophic scar forming. This is often a last resort and usually combined with other treatments, as surgery may result in the formation of a new hypertrophic scar or keloid.
  6. Cryotherapy: This involves freezing the scar with liquid nitrogen to help reduce its size.
  7. Radiotherapy: In rare cases, low-dose radiation may be used to prevent the scar from growing back after it has been surgically removed.

It’s important to remember that treatment might not completely restore the skin to its pre-injury appearance, but it can significantly improve the scar’s color, texture, and size, as well as associated symptoms like itching or discomfort. Each treatment option has its own benefits, risks, and contraindications, so it’s essential to discuss these with a dermatologist to decide the most suitable treatment plan.

Risks and Side Effects

  1. Silicone Sheets and Gels: Generally well-tolerated, but some people may experience skin irritation or rash. There’s also a risk of infection if the silicone sheet isn’t cleaned properly or the skin isn’t thoroughly cleaned before application.
  2. Pressure Therapy: It can cause discomfort or skin irritation. If the pressure garment is too tight, it might also affect blood circulation.
  3. Intralesional Injections: Common side effects include pain at the injection site and skin thinning or color changes. If corticosteroids are used, there’s a risk of the scar becoming larger or more noticeable over time (known as a corticosteroid flare).
  4. Laser Therapy: Risks can include pain, redness, swelling, discoloration of the skin, and blistering. There’s also a small chance of infection or scarring.
  5. Surgery: As with any surgical procedure, there are risks of bleeding, infection, and anesthesia-related complications. Additionally, there’s a risk that the new scar could become a hypertrophic scar or even a keloid.
  6. Cryotherapy: Side effects can include pain, skin discoloration, and blister formation. There’s a small risk of damage to surrounding healthy tissue.
  7. Radiotherapy: Although the doses are low, there’s a slight risk of developing a radiation-induced cancer later in life. Other side effects can include skin redness and dryness, and temporary hair loss if the scar is in a hair-bearing area.

It’s important to discuss these potential risks and side effects with your dermatologist before starting any treatment. They can provide guidance on how to manage side effects and monitor for any complications. It’s also important to remember that not every person experiences side effects, and in many cases, the benefits of treating the hypertrophic scar outweigh these potential risks.

FAQ Section

Hypertrophic scars are caused by an exaggerated response to skin injury or surgery. Factors contributing to their formation include surgical wounds, burns, infections, physical trauma, genetic predisposition, certain ethnic backgrounds, age, and wound location on the body.

Hypertrophic scars are thick, raised, and often red, typically developing within weeks of an injury and confined to the boundaries of the initial wound. They can also cause itching or discomfort. If you think you have a hypertrophic scar, it’s best to consult with a dermatologist for an accurate diagnosis.

Both are types of raised scars, but hypertrophic scars don’t extend beyond the boundary of the original wound and often improve over time, whereas keloids grow beyond the original wound and rarely improve without treatment.

Hypertrophic scars often become flatter and paler over one to two years, but the degree of natural improvement can vary among individuals. Some scars may remain visibly raised and discolored, and additional medical treatment may be necessary.

Treatment options range from non-invasive therapies like silicone sheets and pressure therapy to invasive procedures such as intralesional injections, laser therapy, surgery, cryotherapy, and occasionally radiotherapy. The best treatment depends on individual circumstances and the scar’s characteristics.

Each treatment carries its own potential risks and side effects, from skin irritation and discomfort to more serious issues like infection, bleeding, or changes in skin color. It’s important to discuss these with your dermatologist to make an informed decision about treatment.

While treatments can significantly improve a scar’s appearance and symptoms, they may not completely restore the skin to its pre-injury state. However, many patients experience a significant improvement in their quality of life after treatment.

INDICATION-HYPERTROPHIC SCARS