What Causes a Hypertrophic Scar?

Scar tissue is the body’s repair material. In a hypertrophic scar, collagen production and remodelling remain more active than needed, so the new tissue becomes thick, firm, raised, itchy, tender, or tight. It usually stays inside the boundary of the original cut or wound, which helps distinguish it from a keloid that extends beyond the injury. Infection, delayed healing, wound tension, repeated irritation, and deeper skin damage can influence scar formation. A scar may look red or darker at first and can gradually soften as it matures.

Keep a healing wound clean and follow the dressing instructions provided after an operation or injury. Once the surface has fully closed, a clinician may suggest silicone gel or silicone sheets, pressure therapy, injections, or other scar treatments. Protect the area from sun because new scar tissue can darken. Do not cut, scratch, or repeatedly massage a painful scar without advice. If the scar limits movement or catches on clothing, an assessment can help match treatment to its size, location, age, and symptoms. Surgical excision may be considered in selected cases, but removing a scar creates a new wound that can also scar.

Arrange an assessment if a scar is growing, increasingly painful, very itchy, restricting movement, or repeatedly breaking down. Seek prompt care for spreading redness, warmth, drainage, fever, or sudden swelling around a healing wound. A clinician should review any raised mark that extends beyond the original injury or whose diagnosis is uncertain.

Does this remain within the original wound, or could it be a keloid? Is the surface healed enough for silicone or another treatment? Would injections, pressure therapy, or surgical excision fit this scar’s location and behaviour?