Not every raised, thickened scar is a keloid. A thick, red or pink scar that stays within the lines of your original wound is more likely to be a hypertrophic scar — a different condition with its own causes, timeline, and treatment approach. Here’s what to know about why hypertrophic scars form, how to tell them apart from keloids, and the care options backed by evidence.
What Is a Hypertrophic Scar?
A hypertrophic scar is a thick, raised scar that forms when the skin produces extra connective tissue while healing — an overactive, but ultimately contained, response to the wound. The scar stays within the original wound’s borders, which is the main thing that sets it apart from a keloid.
Scarring happens during the remodeling phase of wound healing, when the skin lays down collagen to repair itself. In a hypertrophic scar, this process produces more collagen — and less of the elastin that normally keeps skin flexible — than a typical healed wound. Researchers don’t yet fully understand why this happens in some wounds and not others.
Hypertrophic Scar vs Keloid
These two scar types are often confused, but a few clear differences help tell them apart (and matter for treatment, so it’s worth reading our full guide to keloid scars if you’re unsure which you have):
- Borders: Hypertrophic scars stay within the original wound. Keloids spread beyond it into healthy skin.
- Colour: Hypertrophic scars tend to be pink to red. Keloids are often red to purple.
- Timeline: Hypertrophic scars usually show up within one to two months of the injury. Keloids can take three months to a year or more.
- Outcome: Hypertrophic scars often flatten and fade on their own over time. Keloids typically persist, and tend to recur even after treatment.
What Causes Hypertrophic Scars?
Several factors make a hypertrophic scar more likely:
- Deep burns: Second- and third-degree burns carry a particularly high risk.
- Wound infection: Infections that slow or complicate healing increase the odds of a hypertrophic scar forming.
- Whole-body inflammation: Conditions that increase inflammation throughout the body can play a role.
- Family history: A genetic tendency toward this type of scarring is recognised, though not fully understood.
Symptoms
Hypertrophic scars feel hard and thickened, and look pink, red, or sometimes purple. They’re most common on the upper trunk and over joints such as the shoulders, elbows, and knees. Many people experience itching, tenderness, or pain, and a scar that sits directly over a joint can occasionally restrict movement.
Timeline: Will It Go Away on Its Own?
Hypertrophic scars typically appear one to two months after the original injury. Because many of them do flatten and soften naturally, doctors often recommend waiting a few months — sometimes up to a year — before starting more intensive treatment, to see how much the scar settles on its own. Gentle, consistent home care during this waiting period, like the options below, can still help.
Treatment Options
- Silicone: Self-adhesive silicone sheets or gel, worn or applied daily for several months or longer, are a widely recommended first step for softening and flattening the scar.
- Pressure garments: Elastic or compression dressings, used consistently, are linked to improved outcomes in several studies.
- Corticosteroid injections: Often the primary medical treatment, these soften the scar and ease pain and itching, usually over several sessions spaced a few weeks apart.
- Laser therapy: Pulsed dye or Nd:YAG lasers can reduce redness by targeting blood vessels in the scar, while fractionated lasers are sometimes used for scars over joints.
- Other options: Bleomycin or 5-FU injections, and cryotherapy (freezing) with liquid nitrogen, are sometimes used for scars that don’t respond to first-line treatment.
- Surgery: Usually a last resort, since the surgery itself creates a new wound that can scar again.
Caring for a Hypertrophic Scar at Home
Once your wound has fully closed, a consistent silicone routine is one of the simplest, most evidence-supported things you can do. Our Rejuvasil Silicone Scar Gel and Scar Fx Silicone Sheeting range are designed for this kind of daily, long-term use. Keeping the scar out of direct sun also matters — new scar tissue burns and discolours more easily than the skin around it, so sunscreen is worth adding to the routine, especially in the first year.
When to See a Doctor
See a dermatologist or your GP if a scar is painful, restricting movement over a joint, not softening after several months of home care, or causing you distress. They can discuss corticosteroid injections, pressure garments, or laser treatment if you’d benefit from more than home care alone.
This page is for general information only and isn’t a substitute for personalised medical advice. Please speak to a dermatologist or doctor before starting any new treatment, especially on a new or still-healing wound.
References
- Cleveland Clinic, “Hypertrophic Scar.”
- Juckett G. “Management of Keloids and Hypertrophic Scars.” American Family Physician.
