Scars are an inevitable consequence of injuries. The deeper and more severe the injury, the greater the resultant scar. However, in certain situations, a scar can be unduly prominent. The scar tissue may raise above the surrounding skin. It may also be associated with symptoms such as itching and deformity. Such a presentation is usually suggestive of a hypertrophic scar.
What causes hypertrophic scarring?
Prolonged healing times can contribute to a hypertrophic scar. In other words, wounds that take a long time to heal are more likely to end up as hypertrophic scars.
In some individuals, there is an inherent tendency to have hypertrophic scars. Sometimes milder injuries can end up as very prominent scars in such individuals. Unfortunately, we can't get rid of this tendency of such patients to have prominent scars.
What are the treatments available for hypertrophic scars?
Certain treatment modalities help prevent and achieve early resolution of hypertrophic scarring. Prevention is recommended in individuals who are prone to such scars. If an individual is prone to such scarring it would be wise to deliberate before going for procedures such as tattoos or piercings. It is also better to bring this to the attention of a surgeon before elective surgery.
The modalities used for prevention and treatment are similar. These include the application of silicone sheet, pressure garments and intralesional injection of immunomodulatory substances. These are usually carried out for prolonged periods for sustained benefits. Surgery has a limited role in the treatment of hypertrophic scars.
Can hypertrophic scars be prevented?
Some measures can reduce the likelihood of such an outcome. They include steps to hasten wound healing. Wounds that take more than two weeks to heal have a higher likelihood of ending up as hypertrophic scars. In individuals who have a history of prominent scars use of silicone sheets and pressure, garments are recommended. In certain situations, we also recommend the use of intralesional agents.
What is the role of surgery in the treatment of hypertrophic scars?
After treatment, the hypertrophic scars usually flatten out and become atrophic. Atrophic scars appear as thinned out and shiny. Surgery is a good option for the management of atrophic scars. The surgical procedures for atrophic scars include scar revision and fat grafting.
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I like to keep it simple.