Treatment of Hypertrophied Scars
Silicone gel sheeting is the first-line treatment for hypertrophied scars due to its proven efficacy and safety profile. This non-invasive therapy has been demonstrated to reduce scar thickness and improve scar appearance in multiple clinical studies 1.
First-Line Treatment Options
Silicone Gel Sheeting
- Apply to the hypertrophied scar for at least 12 hours daily 2
- Continue treatment for 8-12 weeks for optimal results 3
- Clinical improvement typically begins after 4 weeks of consistent use 3
- Mechanism of action appears unrelated to compression, possibly related to hydration and occlusion 3
Silicone Gel (Alternative to Sheeting)
- Easier to apply to visible or irregular areas
- Similar efficacy to silicone sheets
- Apply twice daily to clean, dry scar
Second-Line Treatment Options
If silicone therapy is insufficient after 8-12 weeks, consider:
Intralesional Steroid Injections
- Effective for small, bulky, well-localized hypertrophied scars 4
- Triamcinolone acetonide is commonly used
- Caution: Risk of skin atrophy, hypopigmentation, and systemic absorption
Pressure Therapy
- Useful for more widespread scarring, especially after burns 1
- Requires consistent pressure (24-30 mmHg) for at least 23 hours daily
- Most effective when started early in scar formation
Advanced Treatment Options
For refractory cases or severe hypertrophied scars:
Laser Therapy
- Pulsed dye laser (PDL) effective for early non-proliferating superficial lesions 4
- Can help control residual redness and flatten hypertrophic scars
- Multiple sessions typically required (4-6 weeks apart)
Surgical Excision
- Reserved for scars that fail to respond to conservative measures
- Consider timing carefully - generally not recommended during active proliferation phase
- May be combined with adjuvant therapies to prevent recurrence
Microneedling with PRP
- Shows promise for atrophic scars but may also benefit some hypertrophic scars 5
- Creates controlled micro-injuries that stimulate collagen remodeling
- Protocol: three treatments, 1 month apart, followed by maintenance every 6 months
Monitoring and Follow-Up
- Assess response after 4 weeks of initial therapy
- Document changes in scar thickness, color, and texture
- If no improvement after 8-12 weeks, consider advancing to second-line therapy
- Continue follow-up for at least 6 months as scars can continue to remodel
Potential Complications and Management
- Skin irritation or rash with silicone: Temporarily discontinue until resolved, then resume with shorter daily application times
- Maceration with silicone: Ensure skin is completely dry before application and gradually increase wearing time
- Hypopigmentation with steroid injections: Use lowest effective concentration and limit frequency
Prevention Strategies
For high-risk patients or after scar revision:
- Begin silicone gel sheeting as soon as the wound is fully epithelialized 2
- Maintain wound hydration and minimize tension during healing
- Provide strict UV protection to prevent hyperpigmentation
- Consider early intervention when an "itchy red streak" develops in a maturing wound 2
Hypertrophied scars can significantly impact quality of life, but early intervention with silicone-based products offers the best chance for improvement with minimal risk of adverse effects.