By Gary M. White, MD
A hypertrophic scar is the elevated and excessive growth of fibrous tissue within but not extending beyond the bounds of a scar is characteristic. Keloids by definition extend beyond the area of injury.
A thickened, raised scar is seen. There is no epidermal change. The thickening is dermal. The lesion is usually red.
Patients must have realistic expectations. "Once a scar always a scar." But the appearance can be improved. If treatment is needed, intralesional triamcinolone (10-40 mg/cc Q month) may be injected (see keloids). Some hypertrophic scars have persistent telangiectasias and/or erythema. The flash-pumped dye laser may be tried for these lesions [Derm Surg 1995;21;685]. Covering a scar for 4-5 months with either silicone or non-silicone gel may be helpful in reducing the size and color [Derm Surg 2001;27;721].
According to some experts [e.g. Jill S Waibel MD Miami], almost any scar--burn, traumatic, acne etc.--can be improved with laser therapy. For example pulsed dye laser or IPL are used for erythematous scars and fractional or CO2 laser for thickened scars.
The following are recommended to minimize scar formation after surgery.
Although scar massage is anecdotally effective, there is scarce scientific data in the literature to support it [Dermatol Surg. 2012 Mar;38(3):414-23].
There is a growing body of evidence that either intraoperative or peri-operative interventions can minimize scar formation [JAMA Derm 2015;815]. For example, intraoperative fractional carbon dioxide lasers for sutured wounds and manual dermabrasion for second-intention wounds are advocated. One study of botulinum toxin to prevent the formation of thyroidectomy scars showed compelling results [Wound Repair Regen. 2014;22:605-612.].
Hypertrophic scars after bilateral otoplasty.
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