Hypertrophic Scar Treatment for Red, Raised Scars | IC Clinic Shinjuku
“The site of my surgery has become red and raised.”
“Months have passed since my injury, but the scar is still very noticeable.”
“Will this scar heal on its own, or should I see a doctor?”
If you have been experiencing these kinds of concerns, you may be dealing with a hypertrophic scar (hypertrophic scarring).
A hypertrophic scar is a condition in which excessive skin tissue is produced during the healing process, causing the scar to become red, firm, and raised. Beyond the cosmetic impact, it can also be accompanied by itching, pain, and a feeling of tightness, which may interfere with daily life.
This article covers everything from the symptoms and causes of hypertrophic scars to specific treatment options and lifestyle precautions. Starting treatment at the appropriate time may help improve symptoms, so if you are concerned about scarring, please read on.
What Is a Hypertrophic Scar? How Scars Become Red and Raised
Normally, when the skin is injured, the surface closes within two weeks, and the scar gradually becomes less noticeable over the following six months or so. During the first one to two months, redness may temporarily increase, but it then slowly fades, and the scar eventually becomes a flat, whitish mark (mature scar)—this is the normal healing process.
However, when this normal healing process is disrupted for some reason, collagen fibers produced to repair the wound continue to be overproduced, causing the scar to become red, firm, and raised. This is a hypertrophic scar.
The main symptoms of hypertrophic scars include the following.
- The scar becomes red and raised, resembling a welt
- A stinging pain or itching sensation
- Hardening of the scarred area
- A feeling of tightness or pulling in the skin
- Redness may intensify after bathing or exercise
Hypertrophic Scars vs. Keloids: An Important Distinction That Affects Treatment
Keloids present with symptoms similar to hypertrophic scars. While they look very alike, there are significant differences in how well they respond to treatment and how they progress, making it important to distinguish between the two.
| Hypertrophic Scar | Keloid | |
|---|---|---|
| Extent of Lesion | Remains confined to the original wound area | Spreads beyond the original wound area into surrounding tissue |
| Natural Course | Tends to gradually improve over time (approximately 1–5 years) | Rarely resolves on its own and tends to grow progressively |
| Severity of Symptoms | Pain and itching are relatively mild | Pain and itching tend to be more pronounced |
| Response to Treatment | Responds well to treatment; improvement can be expected | Difficult to treat and prone to recurrence |
| Recurrence After Surgery | Risk of recurrence is relatively low | High recurrence rate with surgery alone; radiation therapy is often required in combination |
In clinical practice, many lesions have characteristics that fall somewhere between hypertrophic scars and keloids, making clear visual differentiation difficult. For this reason, it is important to consult a specialist for a proper assessment and to determine the most appropriate treatment plan.
Who Is Prone to Hypertrophic Scars? Risk Factors and Common Sites
Even with similar injuries, some people develop hypertrophic scars while others do not. Both constitutional factors and local factors are involved.
Constitutional and Systemic Factors
- Keloid-prone constitution: If a family member is prone to hypertrophic scars or keloids, there may be a hereditary predisposition
- Age: More likely to occur in late elementary school age through adolescence; less common in older adults
- Allergic constitution: More common in individuals with allergic conditions such as atopic dermatitis or asthma
- Hormonal influences: Symptoms may worsen during pregnancy due to hormonal changes
- High blood pressure: Hypertension has also been reported as an aggravating factor
Body Sites Prone to Hypertrophic Scars
The likelihood of developing hypertrophic scars also varies by body site. They tend to develop more frequently in areas where the skin is constantly under tension or subject to frequent movement.
| Higher-Risk Sites | Lower-Risk Sites |
|---|---|
| · Anterior chest · Shoulder to upper arm · Back · Lower abdomen (e.g., cesarean section scars) · Ears (e.g., piercing holes) · Joints such as elbows and knees · Jawline and chin area | · Palms · Soles of feet · Top of the head · Eyelids · Lower legs (between the knee and ankle) |
Situations That May Contribute to Hypertrophic Scar Formation
- When the wound is deep
- When the wound becomes infected and takes a long time to heal
- When vigorous physical activity is performed within one to three months of the wound healing
- When acne causes repeated, chronic inflammation
- Scars from cesarean sections or surgical procedures
- Piercing holes or BCG vaccination scars
Can Hypertrophic Scars Heal on Their Own? Understanding the Natural Course
Unlike keloids, hypertrophic scars may improve naturally over time. However, the timeframe varies considerably depending on the location and severity of the condition.
The typical natural course tends to follow these patterns.
- Relatively mild cases: Redness may subside and the raised area may flatten within one to two years
- Sites subject to frequent tension, such as joints: Inflammation may take three to five or more years to settle
- With appropriate treatment: Improvement may occur more quickly than with natural healing alone
While natural improvement is possible, starting appropriate treatment early may help symptoms improve more quickly and can help prevent complications such as scar contracture (tightening). If a scar becomes red and raised, we recommend consulting a physician as soon as possible.
Treatment Options for Hypertrophic Scars
Treatment for hypertrophic scars typically involves a combination of multiple approaches. The most appropriate treatment is selected based on the severity and location of symptoms, as well as the patient’s individual condition.
Conservative Treatment (Non-Surgical)
| Treatment | Details and Features | Estimated Duration |
|---|---|---|
| Compression Therapy | The affected area is compressed and immobilized using tape, sponge, or silicone gel sheets. This helps reduce excess blood flow and minimize physical stress on the scar. | Several months or more |
| Steroid Tape | Available in a milder formulation (Drenizon Tape) and a stronger formulation (Eclar Plaster), used according to the severity of symptoms. Changed once daily, typically at bath time. | 3 months or more |
| Intralesional Steroid Injection | A corticosteroid such as Kenacort is injected directly into the affected area. This may produce a more rapid effect than tape therapy, but the procedure may be associated with discomfort due to the firm nature of the tissue. | Once monthly for 3–6 months or more |
| Oral Medication Therapy | Tranilast (Rizaben), an anti-allergic agent, is taken orally. It may help reduce redness and itching, and can help suppress the proliferation of fibroblasts. | Several months or more |
| Laser Treatment | Laser energy (e.g., Nd:YAG laser) is applied to reduce the number of blood vessels in the affected area. ※ Not covered by insurance | Multiple sessions |
When a single treatment shows insufficient results, or when symptoms are more pronounced, multiple treatments may be used in combination—for example, combining oral medication with steroid tape, or adding steroid injections to areas that have not responded to tape therapy.
When Is Surgery Considered for Hypertrophic Scars?
Surgery may be considered when conservative treatment alone does not produce sufficient results, or in certain specific situations.
Situations Where Surgery May Be Indicated
- When scar contracture (tightening) restricts joint movement
- When the lesion is confined to a small, localized area
- When the scar is in a highly visible location and presents a significant cosmetic concern
- When no improvement is seen despite prolonged conservative treatment
Surgical Approach
During surgery, the hypertrophic scar tissue is partially or fully excised and sutured. The following techniques may be used to help reduce the risk of recurrence.
- Z-plasty or W-plasty may be used to create a zigzag closure that distributes tension across the wound
- Deep tissue layers beneath the dermis are carefully sutured to reduce tension on the skin surface
- For larger areas, skin grafting or flap reconstruction may be performed
It is important to continue conservative treatment after surgery to help prevent recurrence. For several months following the procedure, tape immobilization and steroid therapy are typically used alongside ongoing monitoring. In cases with a strong tendency toward keloid formation, postoperative radiation therapy may also be considered.
Lifestyle Precautions to Avoid Worsening Hypertrophic Scars
Alongside medical treatment, paying attention to the following in daily life may help prevent symptoms from worsening and support recovery.
Keep the Affected Area as Still as Possible
Movements that stretch the scar can aggravate inflammation. In particular, avoid vigorous exercise for three months after the wound forms, and try to keep the affected area as still as possible. Using tape to immobilize the area can also help protect the wound from physical stress.
Sun Protection
While a scar is still in the healing process (approximately six months to one year), exposure to UV rays can make post-inflammatory pigmentation (dark spots) more likely to persist. For scars in exposed areas such as the face or hands, protect the area with medical tape or use sunscreen with SPF 30 or higher.
Precautions Around Bathing, Alcohol, and Exercise
Scars may appear redder after bathing, drinking alcohol, or exercising, but this is a temporary circulatory response and does not represent direct worsening. However, if it occurs frequently it can prolong inflammation, so avoid overly warming the affected area.
Avoid Scratching
Even if you feel itching, scratching the affected area will worsen inflammation. If itching is present, try cooling the area or managing it with prescribed oral or topical medications.
Frequently Asked Questions About Hypertrophic Scars
Yes, hypertrophic scars can develop as a result of acne. When acne inflammation becomes chronic, excessive collagen is produced to repair the area, which can lead to hypertrophic scar formation. The jawline and chin area in particular are sites where the skin moves frequently, making them more prone to this condition. For those who experience repeated acne breakouts, treating the acne itself is also an important consideration.
Treating hypertrophic scars with over-the-counter medications alone is difficult. Steroid tapes (Drenizon Tape, Eclar Plaster) that have recognized effectiveness for hypertrophic scars are prescription-only medications and require a doctor’s prescription. Over-the-counter scar care products are primarily intended for prevention or protection of mild scarring, and their effectiveness for already raised hypertrophic scars is limited. We recommend consulting a dermatology or plastic surgery clinic as soon as possible.
Please consult a dermatology or plastic surgery clinic. If surgery may be required or you are seeking cosmetic improvement, a medical institution with a specialist in plastic and reconstructive surgery is recommended. Since hypertrophic scars often require long-term treatment, choosing a clinic where you can attend consistently is also important.
This varies depending on the severity and location of symptoms, but in general, a treatment period of 3 months to over a year is typically required. At sites subject to frequent movement, such as joints, treatment may take even longer. For steroid injections, sessions are typically administered once monthly for at least 3 to 6 months, and continued care for recurrence prevention is advisable even after symptoms have stabilized.
Even during pregnancy or breastfeeding, some treatments may be possible. However, pregnancy is also a period when symptoms can worsen due to hormonal changes. Steroid injections are generally avoided, and treatment tends to focus on compression therapy and moisturizing care. In some cases, more comprehensive treatment is initiated after breastfeeding has ended. Please consult your physician for further guidance.
Many treatments are covered by health insurance. Steroid tape, steroid injections, oral medications, and surgery can typically be received as covered treatments. However, some treatments such as certain laser therapies are not covered by insurance, so please check with the medical institution in advance.
For Hypertrophic Scar Treatment in Tokyo (Shinjuku), Please Consult IC Clinic Shinjuku
Hypertrophic scarring is a skin condition in which scars become red and raised and may be accompanied by itching or pain. Unlike keloids, improvement can be expected with appropriate treatment, and the earlier treatment is started, the more likely it is to be effective and the sooner symptoms may improve.
If you are unsure whether to leave a scar alone or are wondering what treatment might be right for you, we recommend seeking a medical evaluation first.
At IC Clinic Shinjuku, we propose individualized treatment plans tailored to each patient’s symptoms and lifestyle. If you have concerns about hypertrophic scars, keloids, or scarring in general, please do not hesitate to reach out to us.
References
- Japanese Dermatological Association & Japan Wound Surgery Society. “Clinical Practice Guidelines for the Diagnosis and Treatment of Keloids and Hypertrophic Scars (2018).” Journal of the Japanese Dermatological Association, 128(12), 2503–2512, 2018.
- Japan Society of Plastic and Reconstructive Surgery. “Clinical Practice Guidelines for Plastic Surgery.” 2021 Edition.
- Japan Wound Surgery Society. “On the Treatment of Scars.” 2021.
- Ogawa R. et al. “Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018.” Burns Trauma. 2019.
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine. “Keloids and Hypertrophic Scars.” 2024.
※ The content of this article is intended for informational purposes only and is not a substitute for professional medical diagnosis or treatment. If you have any symptoms, please be sure to consult a qualified physician.
