Hypertrophic scars are thick, raised marks on the skin that develop when the body produces too much collagen during wound healing. Unlike normal scars, these prominent formations stay within the boundaries of the original injury and can be itchy, painful, and limiting. While they may fade over time, many treatment options exist to help manage their appearance and symptoms.

When healing goes beyond normal: understanding treatment goals

When your skin is injured by a burn, surgical cut, or other trauma, the healing process normally produces a flat scar that gradually fades. However, in some people, the body’s healing response becomes excessive, creating thick, elevated scars that can cause discomfort and concern. Treatment for hypertrophic scars focuses on several important goals: reducing the thickness and height of the scar, softening its texture, lightening its color, and relieving symptoms like itching and pain. Another key aim is preventing the scar from restricting movement, especially when it forms near joints.^[1]

The approach to treating hypertrophic scars depends heavily on how long the scar has been present and where it is located on the body. Fresh scars that developed recently often respond better to treatment than older, more established ones. Additionally, the treatment plan must consider whether the scar is causing physical limitations or is primarily a cosmetic concern. Some scars may improve on their own over the course of twelve to eighteen months, gradually becoming flatter and less noticeable. However, many people choose to pursue active treatment to speed this process or to address scars that are not improving naturally.^[2]

Medical societies and dermatology experts have established standard treatment protocols based on years of research and clinical experience. These treatments range from simple, non-invasive approaches like silicone sheets to more complex medical procedures such as injections or surgery. At the same time, researchers continue to investigate new therapies through clinical trials, exploring innovative approaches that may offer better results or work for scars that don’t respond to current treatments.^[3]

Standard treatment approaches: proven methods for scar management

Medical professionals consider several treatments as first-line options for hypertrophic scars, meaning these are typically tried before more aggressive interventions. One of the most widely recommended approaches involves corticosteroid injections, which are considered a practical first-line treatment. These injections deliver powerful anti-inflammatory medication directly into the scar tissue. The steroid helps break down the bonds between collagen fibers, which softens the scar and can make it flatter. Doctors typically inject the medication into the scar every four to six weeks. While this can be highly effective, there is a limit to how many times the procedure can be performed, as repeated steroid injections can weaken the normal tissue surrounding the scar.^[7]

The injections may cause some temporary discomfort, and some people experience side effects such as skin thinning, changes in skin color at the injection site, or small visible blood vessels. However, for many patients, the benefits of reduced scar height and improved texture outweigh these potential drawbacks. The treatment may need to continue for several months to achieve optimal results.^[9]

Silicone gel sheeting represents another cornerstone of hypertrophic scar treatment. This non-invasive approach has been used since the early 1980s and is supported by substantial evidence. Silicone treatment comes in two forms: sheets that are placed directly over the scar and gels that are applied to the skin. The sheets are soft, flexible pads that adhere to the skin and must be worn for extended periods—typically 12 to 24 hours per day for several months. The silicone creates a moist environment under the pad, which research suggests helps regulate collagen production and prevents excessive scar formation.^[9]

Silicone gel offers an alternative for people who cannot wear the sheets, perhaps because the scar is in a visible location or because they sweat heavily. The gel is applied several times throughout the day and dries to form a clear, protective layer over the scar. Both forms of silicone therapy work best when started early in the scar’s development and continued consistently for six to twelve months. Studies have shown that silicone treatments can improve scar appearance slightly compared to no treatment and may reduce pain. However, the evidence comparing silicone to other treatment methods remains limited.^[4]

Pressure therapy is especially useful for preventing and treating hypertrophic scars that develop after burns. This treatment involves wearing specially designed pressure garments or dressings that apply continuous compression to the scar. The pressure limits blood flow, oxygen, and nutrients to the wound area, which in turn reduces the rate of collagen production. For burn survivors, pressure garments are often custom-made and must be worn for 23 to 24 hours per day. Clinical evidence suggests that pressure dressings can reduce hypertrophic scar formation by between 60 and 85 percent, making them highly effective, particularly when wounds take longer than 10 to 14 days to heal or after skin grafting procedures.^[9]

The garments must fit properly and be worn consistently to be effective, which requires significant commitment from the patient. They can be uncomfortable, especially in warm weather, and may need to be replaced as they lose elasticity or as the scar improves. However, for many people, particularly those recovering from extensive burns, pressure therapy is an essential part of scar management that can dramatically improve outcomes.^[20]

Cryotherapy, which uses extreme cold to treat the scar, represents another standard option. During this procedure, liquid nitrogen is applied to the scar tissue, freezing it. This freezing process destroys some of the abnormal collagen and can help flatten the scar. Cryotherapy is most useful for smaller lesions, such as scars from acne, and is often used in combination with other treatments. The procedure can cause temporary pain, blistering, and changes in skin color, particularly in people with darker skin. Multiple treatment sessions are usually necessary.^[9]

Laser therapy has become increasingly popular for treating hypertrophic scars. Different types of lasers work in various ways: some remove damaged layers of skin while others target the blood vessels in the scar or stimulate collagen remodeling. Pulsed dye lasers, for example, are particularly effective at reducing the redness of scars. However, the evidence on laser therapy’s effectiveness compared to other treatments remains uncertain, and more research is needed to determine which types of lasers work best for specific scar characteristics.^[4]

Surgical removal is generally reserved for scars that don’t respond to other treatments. However, surgery alone carries a high risk of the scar returning, sometimes even worse than before. For this reason, surgical excision is almost always combined with other therapies such as corticosteroid injections, silicone sheeting, or radiation therapy to prevent recurrence. The combination approach has shown better success rates than surgery alone.^[9]

Treatment in clinical trials: exploring new possibilities

While standard treatments help many patients, researchers continue to search for more effective approaches, particularly for scars that are difficult to treat or that return after initial therapy. Clinical trials are testing several promising substances and techniques that may eventually become part of routine scar management.

One area of active investigation involves intralesional injections of medications other than corticosteroids. Verapamil, a calcium channel blocker normally used to treat high blood pressure, has shown promise when injected into scar tissue. The medication appears to work by interfering with collagen production and promoting the breakdown of existing collagen in the scar. Early studies suggest it may be beneficial for treatment and prevention of hypertrophic scars, with potentially fewer side effects than corticosteroid injections.^[9]

5-fluorouracil (5-FU), a chemotherapy medication, is being studied as an injection treatment for hypertrophic scars. When injected into the scar, 5-FU inhibits the growth of fibroblasts, the cells responsible for producing collagen. Clinical trials have explored using 5-FU alone or in combination with corticosteroids. The drug can cause local irritation, pain at the injection site, and temporary changes in skin color, but some studies suggest it may be effective for scars that haven’t responded to corticosteroids alone.^[9]

Bleomycin, another chemotherapy agent, has been investigated as an intralesional treatment. This medication works by reducing collagen synthesis and increasing the breakdown of collagen that has already formed. Research indicates that bleomycin injections can help flatten hypertrophic scars and reduce their size. The injections are typically given every few weeks, and multiple treatment sessions are usually needed. Side effects can include pain, skin darkening, and, rarely, more serious complications, so the treatment must be carefully monitored.^[12]

Interferon alfa-2b injections represent another experimental approach. Interferons are proteins that play a role in the immune system’s response to infections. When injected into hypertrophic scars, interferon alfa-2b appears to reduce collagen production and decrease the activity of fibroblasts. Clinical trials have shown some benefit, but the treatment can cause flu-like symptoms and requires multiple injections over several months.^[9]

Topical treatments under investigation include imiquimod 5% cream, a medication normally used to treat certain skin conditions and viral infections. When applied to scars after surgical removal, imiquimod may help prevent the scar from returning by modulating the immune response in the skin. However, it can cause skin irritation, redness, and other local reactions. Research into its effectiveness for hypertrophic scars continues, with studies exploring the best timing and duration of application.^[9]

Some researchers are investigating treatments that target specific molecular pathways involved in scar formation. Transforming growth factor-beta (TGF-β) inhibitors are being studied because TGF-β plays a crucial role in stimulating collagen production during wound healing. High levels of TGF-β are associated with excessive scarring. By blocking this growth factor, researchers hope to prevent hypertrophic scars from forming or to reduce existing ones. These treatments are still in relatively early stages of research, and clinical trials are ongoing to determine their safety and effectiveness.^[3]

Botulinum toxin (commonly known by the brand name Botox) is being explored as a treatment for scars in areas of high tension, such as near joints. The toxin works by temporarily paralyzing muscles, which reduces mechanical stress on the healing wound. This decreased tension may prevent excessive scar formation. Some clinical trials have tested injecting botulinum toxin around surgical incisions immediately after the procedure to prevent hypertrophic scars from developing.^[23]

Advanced laser treatments beyond those already in standard use are also being investigated. Fractional laser therapy creates microscopic columns of treated tissue surrounded by untreated tissue, which may promote better healing with less damage to surrounding skin. Different wavelengths and energy levels are being tested to determine the optimal approach for hypertrophic scars.

Some clinical trials are investigating the use of photodynamic therapy (PDT), which combines light-sensitive medication with specific wavelengths of light to target scar tissue. The treatment aims to reduce fibroblast activity and collagen production. Early research has shown some promising results, but more studies are needed to establish the best protocols.^[15]

Clinical trials for hypertrophic scar treatments are conducted in phases. Phase I trials primarily assess safety, testing new treatments in small groups of people to identify side effects and determine safe dosing. Phase II trials expand testing to larger groups to evaluate effectiveness and further assess safety. Phase III trials compare the new treatment to current standard treatments in large patient populations to determine which approach works better. These trials take place at medical centers in various locations, including the United States, Europe, and other regions around the world.^[3]

Most common treatment methods

• Corticosteroid injections
  • Injections of anti-inflammatory medication directly into the scar tissue
  • Typically given every four to six weeks
  • Helps break down collagen bonds and flatten the scar
  • Considered a practical first-line treatment by medical professionals
• Silicone therapy
  • Available as sheets applied to the scar or as gel applied topically
  • Worn or applied for 12-24 hours daily for six to twelve months
  • Creates a moist environment that helps regulate collagen production
  • Non-invasive option with a good safety profile
• Pressure therapy
  • Custom-made pressure garments or dressings that compress the scar
  • Worn 23-24 hours per day, particularly effective for burn scars
  • Reduces blood flow and oxygen to the scar, limiting collagen production
  • Can reduce scar formation by 60-85 percent when used consistently
• Cryotherapy
  • Application of extreme cold (liquid nitrogen) to freeze scar tissue
  • Destroys abnormal collagen and helps flatten the scar
  • Most useful for smaller lesions such as acne scars
  • Often combined with other treatment methods
• Laser therapy
  • Various types of lasers target different aspects of the scar
  • Some remove damaged skin layers while others target blood vessels
  • Pulsed dye lasers particularly effective for reducing redness
  • Multiple treatment sessions usually required
• Surgical excision
  • Physical removal of the scar tissue
  • High risk of recurrence if used alone
  • Almost always combined with other treatments like injections or radiation
  • Reserved for scars that don’t respond to other approaches
• Experimental injectable treatments
  • Verapamil injections to interfere with collagen production
  • 5-fluorouracil to inhibit fibroblast growth
  • Bleomycin to reduce collagen synthesis
  • Interferon alfa-2b to decrease fibroblast activity
  • Being studied in clinical trials as alternatives to corticosteroids