Hypertrophic scars are usually raised, red lumps that occur over the injured skin, but the definition the outer edge of the scar does not go beyond the original injury.
However, in Clinical practice this definition does not help in deciding on management.
Persistent hypertrophic scars are more prevalent in darker-skinned individuals & those with a family history of scarring.
What can be done about them?
A hypertrophic scar indicates a persistent proliferation phase where uncontrolled collagen is being laid down without maturation when the scar contracts.
There is clearly an inflammatory stimulus that is keeping the process going.
There is certainly evidence available for the presence of Neutrophils in keloid scars from biopsy tissue.
Neutrophils are acute inflammatory cells and have no business being present in an old scar unless inflammation is persisting.
In addition,the benefit of topical or intra-lesional corticosteroids is well established in the management of keloid scars. The steroid can only be working on scars by its ant-inflammatory activity, indicating to inflammation being present.
The presence of inflammation in a scar has a huge implication in its management.
The process of collagen generation is now out of control.
In evolutionary terms, rapid collagen production bestows an advantage as it helps to close a wound &it helps in survival of the species.
However, evolution has no aesthetic sense and the appearance of a scar is not of any interest to it.
Therefore any topical preparation must contain an anti-inflammatory agent to control this collagen formation allowing the scar to heal with rapid maturation.
Salicylic acid 2% is a well established anti inflammatory agent.
Rutin is also proven to have considerable anti-histamine action. Histamine is implicated in the scarring process, as itching in scars is common.
Bromelain is an additional anti inflammatory substance that is used sports injuries.
It is very important to have three categories of ingredients for effective management of hypertrophic scars:
Sealing & hydration:
Silicones e.g.dimethicone&cyclopentasiloxane .
These are inert sealers and very effective in controlling scarring.
Hyaluronic acid works by attaching 1000 molecules of water to each molecule of it. This creates an atmosphere of high moisture that stops the collagen production.
These are essentially Vitamin C10 %,Vitamin A and antioxidants, like Ferulic acid that give the best healing environment to skin cells.
Salicylic acid 2%,Rutin&Bromelain are very effective anti-inflammatory agents.
Unless the above ingredients are present in a topical scar preparation, the results are not going to be optimum.
One preparation designed with all the above ingredient is Scar Repairex®Ultra which is topically used and applied to hypertrophic scars twice daily. This has shown a significant reduction in the size and extent of hypertrophic scars.