Managing Hypertrophic & Keloid Scars: Tips & Treatment Options

The healing process of your skin is often remarkable. When you get a cut or a burn or suffer from severe acne, your body responds by closing the wound with collagen-rich tissue¹, aiming to repair the damage and protect you from further harm. However, sometimes this healing process goes into overdrive, resulting in hypertrophic or keloid scars. These scars are more common than you might think and can appear anywhere the skin has been injured, from small scrapes to significant surgical wounds. What’s more, keloids can even form from seemingly minor injuries, like ear piercings or acne, while hypertrophic scars tend to form along a wound’s edge.

Both keloid and hypertrophic scars have a way of making themselves known, whether they cause discomfort or simply stand out due to their raised and thickened appearance. Keloid scars, in particular, have a reputation for being persistent and growing beyond the original wound boundary. They can be itchy and painful, unlike hypertrophic scars, which are usually limited to the wound area and may flatten with time. Fortunately, if you’re dealing with these scars, you don’t have to resign yourself to a lifetime of raised or discoloured marks. There are treatment options, and understanding what may work for your skin is key to finding relief and improved aesthetics.

The basics: What are hypertrophic and keloid scars?

To better understand what causes hypertrophic and keloid scars, let’s break down the basics. When your skin is injured, collagen (a protein your body uses to rebuild tissue) gets produced rapidly to close the wound. Normally, the collagen fibres align smoothly, resulting in a flat, subtle scar. But in cases of hypertrophic and keloid scars, your body produces an excess of collagen, causing the tissue to form a raised and often red or darker-coloured scar.

Hypertrophic scars are commonly found in areas where the skin is tight², such as the shoulders, back, and chest. They can appear red or purple and are usually itchy or painful. They’re raised, but unlike keloid scars, they don’t extend beyond the wound area and often become less pronounced over time.

Keloid scars, on the other hand, are more aggressive and can continue to grow, invading surrounding healthy skin³. They are most often seen in darker skin types and can develop on the chest, back, shoulders, and earlobes. These scars can be challenging to manage and, in some cases, may even cause functional limitations if they form over joints or cover a large area of skin.

Treatment options for hypertrophic and keloid scars

Managing hypertrophic and keloid scars often requires a multi-pronged approach, as no one treatment works for every scar type or every individual. Here are some of the common treatments available, each with its own set of benefits and limitations.

1. Topical silicone gels and sheets: One of the most effective first-line treatments for both hypertrophic and keloid scars is the application of silicone gels or sheets. These products work by hydrating and flattening the scar tissue while minimising the redness associated with the scar. They are easy to use and can be applied long-term, but results may take weeks to months to become apparent.

2. Intralesional steroid injections: These injections are frequently used to reduce the size and discomfort of keloid and hypertrophic scars. The steroids help break down the collagen in the scar tissue, flattening and softening the scar. Multiple treatments are often needed, and while this approach can be effective, it is not without side effects, such as thinning of the skin.

3. Laser treatments: Modern advancements in dermatology have brought laser therapy to the forefront of scar treatment. Pulsed dye lasers target blood vessels in the scar, reducing redness, while CO2 lasers help in resurfacing and flattening the scar. Laser treatments can be highly effective especially when used in combination for synergistic results, but may require multiple sessions depending on severity, and are best performed in a dermatology clinic equipped with the latest technologies.

4. Cryotherapy: This involves freezing the scar tissue using liquid nitrogen, which can be beneficial for small, newly formed keloid scars. The cold temperature destroys the scar tissue, but there’s a risk of skin discolouration, making it more suitable for lighter skin tones.

5. Pressure therapy: Applying pressure garments over the scar can be helpful, particularly after burns or surgical procedures. The pressure helps to flatten and soften the scar over time. This method is commonly used in conjunction with other treatments for optimal results.

Caution with surgical excision

While it may seem logical to remove keloid scars surgically, this approach often comes with a significant risk of recurrence. In fact, the new scar tissue formed after surgery can be even larger and more problematic. This is why excision is only recommended in highly select cases, often paired with other treatments like steroid injections or radiation therapy to prevent the keloid from returning.

Practical tips for scar prevention and care

While treatment options abound, prevention is always better than cure when it comes to scarring. If you know you’re prone to developing keloids or hypertrophic scars, be cautious about undergoing elective surgeries or even minor procedures like ear piercings. Protect healing wounds from the sun, as UV exposure can worsen the appearance of scars, making them darker and more pronounced. You can also explore non-invasive options like silicone sheets or pressure garments if you have a history of problem scars.

Skin health is complex, and developing scars is just one of many hurdles you may encounter. It’s essential to remember that the key attributes for beautiful skin include not just aesthetics but the overall health and well-being of your skin. When managed with care, even stubborn scars can improve significantly, boosting your confidence and comfort in your skin.

Conclusion

Scars can be a source of distress, but they don’t have to define your relationship with your skin. For expert guidance and cutting-edge treatment options, consider visiting Angeline Yong Dermatology. Dr Angeline Yong provides comprehensive, all-round dermatological services to patients. With her signature personalised care, Dr Yong takes the time to understand your concerns and conditions, ensuring that your treatment regimen is as unique as you are.

References

Scars: Treatment and cause. Cleveland Clinic. (2024, October 23). https://my.clevelandclinic.org/health/diseases/11030-scars

Hypertrophic scar: What is it, causes, treatment. Cleveland Clinic. (2024, October 23). https://my.clevelandclinic.org/health/diseases/21466-hypertrophic-scar

Keloids. National Skin Centre. (n.d.-b). https://www.nsc.com.sg/patients-and-visitors/Health-Library/Conditions-And-Treatments/Pages/Keloids.aspx

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Managing Hypertrophic & Keloid Scars: Tips & Treatment Options