Hypertrophic Scars: A Comprehensive Guide to Causes, Symptoms, and Management
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
A hypertrophic scar is a thick, raised scar that stays within the original wound boundaries, caused by overproduction of collagen during healing. It commonly forms on taut skin such as the chest, back and joints, and may be pink to purple, itchy or tender. A provider diagnoses it by exam, and treatments include steroid injections, laser therapy and silicone gel. [1]
What the research says
Silicone gel sheeting has only weak evidence behind it. A Cochrane review of 20 trials (873 people) found weak evidence that silicone gel sheeting lowers the chance of abnormal scarring in high-risk people (risk ratio 0.46, 95% CI 0.21–0.98), and treatment trials showed thinner, less red scars, but the studies were highly susceptible to bias. (O'Brien & Jones, Cochrane Database of Systematic Reviews, 2013)
Pressure garments after burns remain unproven. A Cochrane review of 15 studies (1,179 participants) judged the evidence on pressure-garment therapy for preventing hypertrophic scarring after burns to be very uncertain, and concluded that patient preference may reasonably guide the choice. (Harris et al., Cochrane Database of Systematic Reviews, 2024)
Steroid injections and 5-FU are accepted second-line options, while laser evidence is largely anecdotal. An expert panel's scar-management guidelines (written for Asian patients) rated silicone as first-line prevention, listed intralesional steroid, 5-fluorouracil injections and radiation for non-responders, and noted that evidence for lasers is largely anecdotal with no consensus on settings. (Kim et al., Plastic and Reconstructive Surgery, 2013)
What is a hypertrophic scar?
A hypertrophic scar is an abnormal response to skin trauma where the body creates an excessive amount of connective tissue. While most scars eventually flatten and fade, a hypertrophic scar remains raised and thickened. This occurs because the body's repair mechanism produces extra collagen while simultaneously decreasing elastin, resulting in a stiff, prominent scar. [1]
These scars are most frequently seen in areas where the skin is under constant tension or movement. While they are not dangerous or life-threatening, they can be a source of physical discomfort and self-consciousness. In some cases, if a hypertrophic scar forms directly over a joint, it can physically limit the range of motion, necessitating medical intervention. [1]
Hypertrophic scars vs. keloids
It is common to confuse hypertrophic scars with keloids, as both appear as raised tissue. However, they have distinct clinical characteristics that influence how they are treated.
Feature | Hypertrophic scar | Keloid |
Growth pattern | Stays within the original wound area | Extends beyond the wound boundaries |
Appearance | Pink to red color | Red to purple; can grow very large |
Microscopic view | Collagen fibers arranged parallel to the skin | Disorganized, random collagen arrangement |
Development time | Appears 1–2 months after injury | Can develop months or years later |
Treatment success | Generally easier to treat | High recurrence rate; harder to manage |
Long-term outlook | May flatten or fade on its own | Permanent without medical treatment |
Recognizing the symptoms
The signs of a hypertrophic scar are typically easy to identify during the healing process. They usually begin to develop within one to two months after the initial skin injury.
Physical texture: The tissue feels hard, thickened, and significantly raised above the surrounding skin.
Coloration: The scar often appears pink, red, or even purple depending on the age of the scar and the individual's skin tone.
Sensation: Many people report that the area feels itchy, tender, or even painful to the touch.
Mobility issues: If the scar is located on an elbow, knee, or shoulder, it may feel tight and restrict normal movement. [1]
Causes and risk factors
Hypertrophic scars form during the "remodeling" phase of wound healing. While the exact reason why the repair process goes haywire is not fully understood, several factors increase the likelihood of this occurring.
Skin tension: Areas of the body where the skin is pulled tight—such as the upper back, chest, and shoulders—are the most common sites for these scars.
Deep injuries: Second- and third-degree burns are significantly more likely to result in hypertrophic scarring than superficial wounds.
Infection and inflammation: Poor wound healing due to an active infection or systemic (whole-body) inflammation can trigger the overproduction of collagen.
Genetics: A family history of raised scarring can increase an individual's risk, although this is more strongly linked to keloids. [1]
Effective management and treatment
Dermatologists and plastic surgeons often wait several months before beginning treatment to see if the scar will flatten on its own. If the scar persists, several clinical and home-based options are available.
Corticosteroid injections: This is considered a primary treatment. Injections directly into the scar tissue help to flatten and soften the area while reducing itchiness.
Laser therapy: Specialized lasers can target blood vessels within the scar to stop its growth and lighten its color. Fractionated lasers are particularly useful for softening stiff scars over joints.
Silicone sheets and gels: These are widely used home treatments. Wearing silicone sheets daily for several months is commonly recommended to help reduce the size and redness of a developing scar.
Cryotherapy: Using liquid nitrogen to freeze the scar tissue can destroy the excess collagen and help the scar flatten.
Pressure therapy: Spandex bandages or elastic wraps applied over a moist dressing may help reduce the formation of raised tissue during the early stages of healing. [1]
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Frequently Asked Questions
Will a hypertrophic scar ever go away on its own?
Unlike keloids, hypertrophic scars may become less noticeable and flatten slightly over several years, but they rarely disappear completely without treatment.
Are hypertrophic scars cancerous?
No, hypertrophic scars are benign (non-cancerous) growths. While keloids have a slightly higher risk of changing, hypertrophic scars are generally considered safe.
Can I get a hypertrophic scar from a small cut?
While they are more common with deep wounds and burns, a hypertrophic scar can form from any skin injury, including surgical incisions or accidental trauma.
How long should I wear silicone sheets?
For the best results, silicone sheets should be worn every day, all day, for at least three to six months.
Is surgery the best way to remove a hypertrophic scar?
Surgery is usually a last resort. Because surgery creates a new wound, there is a risk that a new, even larger hypertrophic scar will form in its place.
Does Vitamin E help with hypertrophic scars?
While many people use Vitamin E, there is limited clinical evidence that it is as effective as silicone gel or medical treatments for raised scars.
Can children get hypertrophic scars?
Yes, children are actually more prone to hypertrophic scarring because their skin is highly elastic and their healing processes are very active.
Why do these scars itch so much?
The itching is often caused by the high levels of collagen and the activity of fibroblasts (cells that build tissue) during the remodeling phase.
Can I prevent a hypertrophic scar after surgery?
Following your surgeon's instructions for wound care, and using silicone sheets and pressure therapy where recommended, can help reduce the risk.
What is the difference between a scar and a hypertrophic scar?
A normal scar is flat and eventually matches the surrounding skin color. A hypertrophic scar is raised, thick, and remains pink or red for a long time.
Is laser therapy painful?
Most patients describe laser therapy as feeling like a rubber band snapping against the skin. Topical numbing creams are often used to minimize discomfort.
Can hypertrophic scars form on the face?
Yes, they can form anywhere on the skin, although they are less common on the face than on the trunk of the body.
Do these scars ever turn into keloids?
No, a hypertrophic scar and a keloid are two different types of abnormal healing. A hypertrophic scar will not "turn into" a keloid.
How many steroid injections will I need?
Most patients require a series of injections, usually spaced several weeks apart, to see significant flattening.
Can massage help flatten a scar?
Some dermatologists recommend gentle scar massage once the wound is fully closed to help break up collagen fibers, but it should be done under medical guidance.
Related Reading
Breast Reduction Scars: Healing Timeline, Types and Treatment explains how breast reduction scars heal.
References
Cleveland Clinic. Hypertrophic Scar: What Is It, Causes, Treatment. Cleveland Clinic. Last updated June 1, 2021. https://my.clevelandclinic.org/health/diseases/21466-hypertrophic-scar
O'Brien L, Jones DJ. Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev. 2013;2013(9):CD003826. PMID 24030657. https://doi.org/10.1002/14651858.CD003826.pub3
Harris IM, Lee KC, Deeks JJ, et al. Pressure-garment therapy for preventing hypertrophic scarring after burn injury. Cochrane Database Syst Rev. 2024;1(1):CD013530. PMID 38189494. https://doi.org/10.1002/14651858.CD013530.pub2
Kim S, Choi TH, Liu W, et al. Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg. 2013;132(6):1580-1589. PMID 24281584. https://doi.org/10.1097/PRS.0b013e3182a8070c
Medical disclaimer
The information provided in this article is for educational purposes only and should not be considered medical advice. If you have a scar that is painful, growing, or changing, consult a dermatologist or plastic surgeon immediately.
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