Often confused with keloids, hypertrophic scars are caused by impaired healing process. However, this type of scar can have a spontaneous regression that is accelerated with the appropriate treatments.

They are raised scars that protrude from the skin that surrounds them, which is why they are usually very unsightly, although perhaps not as unsightly as keloids, and they run the risk of suffering more infections, rubbing and injuries than other scars.

Current aesthetic medicine makes it possible to diminish their appearance, reduce their relief and improve their appearance, even eliminating them in some cases, through various treatments that aim to hide and correct these skin lesions.

What are hypertrophic scars?
Hypertrophic scars are born due to improper wound treatment. They are caused by an excess production of collagen in the skin, generated by the mechanical traction that the dermis undergoes when it heals. They are visible to the naked eye as a raised cord that can also be itchy and painful. They usually manifest from the second week of wound healing, being able to regress spontaneously thanks to topical or surgical accelerator treatments.

Often, people who suffer from hypertrophic scars tend to confuse them with keloids, although these present well marked differences. Keloids are more extensive, invasive and in some cases more annoying, while in hypertrophic scars the extension occurs without exceeding the limits of the scar. Keloids do not regress like hypertrophic ones and are much more difficult to remove. Furthermore, they present a high risk of recurrence even after surgical removal.

How to remove them
The hypertrophic scars can be treated by topical or surgical processes. It is important to go to a dermatologist who makes a correct diagnosis and applies the appropriate therapy to each type of skin and scar. In any case, it is always advisable to wait a year from the date it occurred, since the scar, especially during the first three months, can change over time. Whether or not it is hypertrophy, as a preventive measure, all scars must be kept under control.

Among the most used topical and surgical treatments we find the following:

Topical products. Among them, the most used are silicone gels and sheets and vitamin E. Silicone products are one of the first prescribed methods for scar improvement, but it is also often recommended to prevent its appearance after surgical procedures. Its use substantially improves the appearance of these lesions, does not entail side effects and its application is extremely simple. With regard to vitamin E, this is a natural scar treatment. It is usually available through gels, oils, or capsules and should be applied to the clean lesion.

Corticosteroid injections intralesionally. It consists of the injection of corticosteroids into the scar itself and is one of the usual treatments for the correction of these dermal lesions. The purpose is to slow down the excessive production of fibroblast collagen and to control the oxygenation of the scar. In addition, it reduces its volume. Among the risks of this treatment is the possible alteration of skin pigmentation, which tends to lighten, atrophy and the appearance of telangiectasias.
5-fluorouracil injections.This substance is usually used mainly for the treatment of cancer, but some specialists are also using it for the treatment of hypertrophic and keloid scars. It is a drug that prevents the formation of DNA, which results in a slowdown in cell duplication and division. This leads to an improvement in the scar, which reduces its volume and flattens. Treatment with 5-fluorouracil consists of a weekly or biweekly injection for three months and can be used alone or in combination with other treatments, such as corticosteroid injections (the results achieved with triamcinolone acetonide stand out) or the pulsed dye laser. Among the adverse effects of this treatment, specialists point out burning, pain, darkening of the skin, ulceration of the scar,
Dermabrasion It is a surgical intervention, carried out under local anesthesia, which thins and softens the scar by smoothing the skin. With this treatment it is possible to reduce the volume of the lesion, but, as in the case of most of the treatments discussed, it does not disappear completely, but is concealed. Among the adverse reactions of this treatment we must mention darkening of the skin, skin redness, pain, infection, etc.
Laser treatment. There are three types of lasers used for the treatment of hypertrophic scars: the pulsed dye laser (PDL), the ablative laser (AFL) and the non-ablative laser (NAFL). Among them, the most used are the Dye laser or KTP laser. The objective of its application is to improve the volume, elasticity and color of the scar, as well as the blood and lymphatic vessels of the injury and promote the production of type III collagen. Despite being a safe treatment, it can have side effects, such as darkening of the skin and the appearance of petechiae or spots.
Cryotherapy. It is another intralesional treatment, as in the case of injections, since, by means of needles, cold is applied to the scar. Its main advantage is that it reduces the size and thickness of the lesion, thereby improving its aesthetic appearance. Among the side effects we must highlight darkening of the skin, pain, edema …
Complete removal by surgery. Through intralesional excision, carried out in the case of keloids, the risk of reappearance is avoided. In hypertrophic scars, complete abscission is performed.

To obtain satisfactory results, it is necessary for the doctor to thoroughly examine the hypertrophic scar and, based on the patient’s history, evaluate the best treatment to follow, always personalized, a treatment that improves the aesthetics of the lesion and, therefore, of the patient himself.