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Hypertrophic scar

Hypertrophic scar
Hypertrophic scar (4 months after incident)
SpecialtyDermatology

A hypertrophic scar is a cutaneous condition characterized by deposits of excessive amounts of collagen which gives rise to a raised scar, but not to the degree observed with keloids.[1] Like keloids, they form most often at the sites of pimples, body piercings, cuts and burns. They often contain nerves and blood vessels. They generally develop after thermal or traumatic injury that involves the deep layers of the dermis and express high levels of TGF-β.[citation needed]

Cause

Mechanical tension on a wound has been identified as a leading cause for hypertrophic scar formation.[3]

When a normal wound heals, the body produces new collagen fibers at a rate which balances the breakdown of old collagen. Hypertrophic scars are red to brown and thick and may be itchy or painful. They do not extend beyond the boundary of the original wound, but may continue to thicken for up to six months. Hypertrophic scars usually improve over one or two years, but may cause distress due to their appearance or the intensity of the itching; they can also restrict movement if they are located close to a joint.[4][dubious – discuss]

Some people have an inherited tendency to hypertrophic scarring, for example, those with Ehlers–Danlos syndrome.[citation needed]

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. For example, pressure garment therapy is a commonly used approach used to try and prevent hypertrophic scarring after a burn, but the effectiveness of this approach is unclear.[5]

Management

Early hypertrophic scars should be treated with applied pressure and massage in the first 1.5–3 months.[6] If necessary, silicone therapy should be applied later. Ongoing hypertrophy may be treated with corticosteroids injections.[6] Surgical revision may be considered after 1 year.[7]

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.[8] It is uncertain whether silicone gel sheets are more effective than other treatment approaches.[8]

Laser therapy

Laser therapy is an approach that has been studied for treating hypertrophic scars.[9] 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 benefits as compared with no treatment or different kinds of treatment.[9]

Cryosurgery

Cryosurgery, using extreme cold to remove dead tissue, may speed up the healing process from a hypertrophic scar to a flatter, paler one.[10][needs update]

See also

References

  1. ^ Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN 978-1-4160-2999-1.
  2. ^ Jeschke MG, Kamolz LP, Sjöberg F, Wolf SE (23 August 2012). Acute Burn Care. Handbook of Burns. Vol. 1. Springer Science & Business Media. ISBN 978-3-7091-0348-7.
  3. ^ Yagmur C, Akaishi S, Ogawa R, Guneren E (August 2010). "Mechanical receptor-related mechanisms in scar management: a review and hypothesis". Plastic and Reconstructive Surgery. 126 (2): 426–434. doi:10.1097/PRS.0b013e3181df715d. PMID 20375759. S2CID 23828914. cited in Acute Burn Care (2012) page 332.[2]
  4. ^ "UpToDate". www.uptodate.com. Retrieved 2024-05-29.
  5. ^ Harris, Isobel M.; Lee, Kwang Chear; Deeks, Jonathan J.; Moore, David J.; Moiemen, Naiem S.; Dretzke, Janine (2024-01-08). "Pressure-garment therapy for preventing hypertrophic scarring after burn injury". The Cochrane Database of Systematic Reviews. 1 (1): CD013530. doi:10.1002/14651858.CD013530.pub2. ISSN 1469-493X. PMC 10772976. PMID 38189494.
  6. ^ a b Juckett G, Hartman-Adams H (August 2009). "Management of keloids and hypertrophic scars". American Family Physician. 80 (3): 253–260. PMID 19621835.
  7. ^ Cooper JS, Lee BT (December 2009). "Treatment of facial scarring: lasers, filler, and nonoperative techniques". Facial Plastic Surgery. 25 (5): 311–315. doi:10.1055/s-0029-1243079. PMID 20024872. S2CID 260136591.
  8. ^ a b Jiang Q, Chen J, Tian F, Liu Z, et al. (Cochrane Wounds Group) (September 2021). "Silicone gel sheeting for treating hypertrophic scars". The Cochrane Database of Systematic Reviews. 2021 (9): CD013357. doi:10.1002/14651858.CD013357.pub2. PMC 8464654. PMID 34564840.
  9. ^ a b Leszczynski, Rafael; da Silva, Carolina AP; Pinto, Ana Carolina Pereira Nunes; Kuczynski, Uliana; da Silva, Edina MK (2022-09-26). Cochrane Wounds Group (ed.). "Laser therapy for treating hypertrophic and keloid scars". Cochrane Database of Systematic Reviews. 2022 (9): CD011642. doi:10.1002/14651858.CD011642.pub2. PMC 9511989. PMID 36161591.
  10. ^ Zouboulis CC, Blume U, Büttner P, Orfanos CE (September 1993). "Outcomes of cryosurgery in keloids and hypertrophic scars. A prospective consecutive trial of case series". Archives of Dermatology. 129 (9): 1146–1151. doi:10.1001/archderm.1993.01680300074011. PMID 8363398.
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