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Overview

What Is a Hypertrophic Scar?

A hypertrophic scar is raised, thickened scar tissue caused by an overactive healing response after the skin is injured. It forms when the body makes extra collagen while repairing the wound. Unlike a keloid, it usually stays within the boundaries of the original injury. Over time, a hypertrophic scar may fade in color and become softer or flatter, although this can take months.

Hypertrophic scar

A raised, thickened scar that remains within the edges of the original wound.

Keloid scar

A scar that grows beyond the edges of the original wound into nearby skin.

Symptoms

Symptoms and Appearance

A hypertrophic scar may look and feel different depending on its location, size, age, and your skin tone. Some scars cause no discomfort, while others itch, hurt, or feel tight. The appearance and symptoms may change as the scar matures.

  • A raised or thickened area of scar tissue.
  • A red, pink, purple, brown, or darker color than the surrounding skin.
  • Itching at or around the scar.
  • Tenderness when the scar is touched.
  • Pain in the scar or nearby skin.
  • A feeling of tightness over the scar.
  • Limited movement when the scar is near a joint.
  • Sensitivity to rubbing from clothing or other contact.

Causes

Causes: How Hypertrophic Scars Form

Scar tissue forms as the body repairs damaged skin. During normal healing, collagen helps strengthen the repaired area, but excess collagen or prolonged inflammation can make the scar thicker and raised. This process can lead to hypertrophic scarring after injuries, procedures, or ongoing inflammation.

  • Surgery or another procedure that cuts the skin.
  • Cuts, puncture wounds, or other traumatic injuries.
  • Burns.
  • Acne or another condition that causes skin inflammation.
  • Tattoos or piercings.
  • Wounds that heal under tension.
  • Wounds that become infected or stay inflamed during healing.

Risk Factors

Risk Factors for Hypertrophic Scars

Factors you cannot change

  • A personal history of hypertrophic or keloid scars.
  • A family history of raised scars.
  • Younger age.
  • Darker skin pigmentation.
  • A wound over the chest or shoulders.
  • A burn, large injury, or deep wound.
  • A wound that remains inflamed for a prolonged period.

Factors that may affect healing

Infection, delayed wound closure, repeated injury, excess tension, and poor wound care may increase the chance of a hypertrophic scar. Following wound-care instructions can support healing, but it cannot guarantee a flat scar. A person may develop one even when the wound receives appropriate care.

Complications

Possible Complications

  • Persistent itching can make the scar difficult to ignore.
  • Ongoing pain may occur in or around the scar.
  • Tight skin may make stretching uncomfortable.
  • A scar near a joint may reduce movement.
  • The scar may be sensitive to friction.
  • The scar may make clothing or activities uncomfortable.
  • Concern about appearance may cause emotional distress.

Complications from a hypertrophic scar are usually not dangerous, but a scar that is rapidly changing, very painful, draining, or limiting movement deserves medical assessment.

Treatment & Management

Treatment and Management

Treatment depends on the scar’s age, size, location, symptoms, skin type, and effect on movement. Some scars gradually flatten without treatment, while others need products, injections, or procedures to reduce thickness and discomfort. A clinician can help choose an approach based on the individual scar.

ApproachTypical useWhat to know
Observation and skin careSmall or improving scarsMonitor changes, moisturize healed skin, and protect it from the sun
Silicone gel or sheetsRaised or newly healed scarsUse only on fully closed skin and follow product or clinician instructions
Steroid injectionsThicker, itchy, or painful scarsGiven by a clinician and may require repeat treatment
Pressure therapySelected raised scars, especially after burnsRequires consistent use and professional guidance
Laser or other light-based treatmentPersistent color, thickness, or texture changesResults vary and several sessions may be needed
CryotherapySelected smaller or thicker scarsMay cause temporary color changes and is performed by a clinician
Surgical scar revisionPersistent or function-limiting scarsDiscuss recurrence risk and expected results with a specialist

Prevention

Can Hypertrophic Scars Be Prevented?

  • Follow the wound-care instructions provided after an injury or procedure.
  • Seek medical care if the wound shows signs of infection or is healing slowly.
  • Avoid picking at the wound or causing repeated friction or injury.
  • Protect fully healed skin from sun exposure with clothing or sunscreen.
  • Use silicone products only on closed skin when a clinician recommends them.
  • Tell surgeons or piercers if you have a history of raised scars.

These steps may lower the risk of abnormal scar tissue, but prevention cannot guarantee a flat scar. The chance of hypertrophic or keloid scars can remain higher in people with a personal or family history of raised scars.

Outlook and Prognosis

Outlook and Prognosis

A hypertrophic scar may remain raised or symptomatic for months before gradually becoming softer, flatter, and lighter or darker in color. Some scars remain noticeable, and a scar can recur after treatment. The long-term course depends on factors such as its size, location, age, and the individual’s tendency to form raised scars.

When Should You See a Doctor

When Should You See a Doctor?

Seek medical advice

Have a changing or troublesome scar checked

Arrange medical assessment if the scar is rapidly enlarging, painful, infected, bleeding, draining, or restricting movement. It is also important to seek advice when a scar develops after a procedure in someone with a history of raised scars, or when it is difficult to distinguish from a keloid or another skin condition.

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