Hypertrophic Scars: Signs, Causes, and Treatment Options
A hypertrophic scar is raised or thickened scar tissue that remains inside the boundary of the original injury. A keloid can grow beyond that boundary. The distinction helps frame a clinical conversation, but appearance alone cannot confirm what a mark is or which treatment is appropriate.
What is a hypertrophic scar?
A scar forms while skin repairs an injury. If the healing response creates thicker, raised tissue than usual, the result may be called a hypertrophic scar. The key boundary clue is that the raised tissue stays within the area that was injured.
These scars often become noticeable in the weeks after an injury. They may look pink or red, feel firm or slightly raised, and sometimes be itchy, sore, or tight. Their color can look different across skin tones, so color by itself is not a dependable way to identify one.
Signs and symptoms to notice
A hypertrophic scar can be a narrow raised line along a surgical incision, a thicker patch after a burn, or a raised area where inflamed skin healed. Its shape often follows the original injury rather than expanding into nearby, previously uninjured skin.
Some scars are mainly a change in texture. Others also have visible redness or darker coloring. A scar can be mildly noticeable or more symptomatic; there is no single look that proves the diagnosis.
Common symptoms to mention at an appointment include itch, tenderness, sensitivity to touch, a pulling sensation, or discomfort when the area stretches. Avoid scratching or aggressive scrubbing: irritation can make already sensitive skin harder to manage.
Hypertrophic scar vs. keloid vs. a flat acne mark
The most useful first distinction is the wound boundary. A hypertrophic scar remains within it; a keloid may grow past it. The timing, symptoms, body location, and whether the mark changes over time also matter. These patterns guide an assessment but do not replace one.
| What you notice | What it may suggest | Useful next step |
|---|---|---|
| Raised tissue that follows the original wound outline | May fit a hypertrophic scar. | Note when it appeared and whether it is changing, itchy, painful, or tight. |
| Raised tissue that continues beyond the original wound | Can suggest a keloid or another raised skin condition. | Arrange an assessment, especially before considering a procedure. |
| A flat brown, gray, red, or purple area after acne | May be a post-inflammatory color change rather than a raised scar. | Read our guide to Korean skincare for post-blemish marks. Products for flat discoloration do not flatten raised tissue. |
| A shallow dip or uneven surface after acne | May be an atrophic acne scar, a different pattern from a raised scar. | Start with the acne history and discuss persistent texture changes with a dermatologist. |
Hypertrophic scars and keloids can be difficult to tell apart, and some raised marks are not scars at all. A clinician may ask about the injury and when the mark appeared, examine its edge and texture, and consider other causes if the history does not fit.
When a raised mark may need a diagnosis first
If a bump appeared without a remembered injury, grows in an unexpected way, or changes in color or surface, do not assume that it is a scar. Some unrelated skin conditions can resemble one. A dermatologist can decide whether examination alone is enough or whether another test is needed.
Book a medical assessment for a new raised area without a clear injury history, or for a mark that bleeds, breaks down, changes unexpectedly, or keeps enlarging. This is especially important before using a scar treatment on an uncertain diagnosis.
Why do hypertrophic scars form?
They can follow injuries that involve the deeper skin, including surgery, burns, cuts, and some inflammatory skin injuries. Acne can also leave a raised scar, though flat color change and depressed scars are more common acne after-effects.
The healing process is complex, and no single cause explains every raised scar. The risk may be higher when healing skin is under tension. That is one reason raised scars are often discussed around areas such as the shoulders, chest, upper arms, or joints.
A wound that moves or stretches repeatedly can put tension on the healing area. This does not mean a person caused the scar by moving normally; it explains why location and wound history are useful details for a clinician.
If acne is still active, separating breakouts from their after-effects can help set expectations. See our overview of acne causes and routine guide for acne-prone skin. Those resources cover acne care, not treatment for a diagnosed raised scar.
How a hypertrophic scar can change over time
A raised scar may become visible within weeks of an injury and can continue to thicken during early healing. A patient guide from Royal Free London says hypertrophic scars may thicken for up to six months and often improve over 12 to 24 months. Those ranges describe a general pattern, not a promise or a deadline for an individual.
Change may be gradual. A scar can remain raised while its color or discomfort shifts, and not every person follows the same course. It can be useful to record when the injury happened, when the mark changed, and whether itch, pain, or movement restriction is new.
If you take progress photographs, use similar lighting and distance and keep them private if they show identifiable areas. Photos can help you describe a change, but they cannot establish a diagnosis or tell you which intervention will work.
Treatment options and what the evidence can tell you
Treatment depends on the diagnosis, scar age, symptoms, location, and personal preferences. Some hypertrophic scars improve without an intervention. If a scar is painful, very itchy, growing, or limiting movement, a dermatologist can discuss whether to monitor it or treat it.
Silicone sheets and gels
A clinician may discuss silicone sheeting or gel after the wound has fully closed. It should not be placed over an open or unhealed wound. Ongoing use can irritate some skin; redness, rash, or skin breakdown are reasons to stop and ask for medical guidance.
The evidence is not as certain as product claims sometimes imply. A Cochrane review found 13 studies involving 468 people and judged the evidence low or very low certainty. It was uncertain whether silicone sheets improved appearance more than most comparison treatments. A clinician can explain whether a particular silicone product fits your scar and how to use it.
The store listing describes the product below as a topical gel for the appearance of scars and uneven texture. This page does not present product-specific clinical evidence for a diagnosed hypertrophic scar, so the card is a shopping link, not a claim that the gel will flatten raised tissue or replace a dermatologist’s plan.
CENTELLIAN24 Proceutical Scar Gel 15g
See the current store listing for product details. It is a topical skincare product, not a substitute for assessment or a clinician-directed plan for a raised scar.
Treatments a dermatologist may discuss
Depending on the scar and diagnosis, a clinician may discuss steroid injections, pressure therapy, laser or light treatment, or another procedure. These options have different goals and risks. For example, steroid injections can cause skin thinning or dark spots, while procedures may require more than one visit and follow-up care.
Ask what the treatment is intended to change: height, color, itch, pain, or movement. Also ask how much improvement is realistic, how long treatment may take, what side effects to watch for, and what happens if the scar returns or does not respond.
How a clinician matches treatment to a scar
Two raised scars can look similar in a photograph and still call for different plans. The clinician first checks whether the mark is a hypertrophic scar, a keloid, or another skin change. Then the plan can target the concern that matters most: height, firmness, itch, tenderness, color, or restricted movement. A plan for appearance alone may differ from one intended to make a shoulder or joint move more comfortably.
Before a treatment is chosen, describe when the injury happened, how the mark has changed, what you have already tried, and whether a prior treatment helped or caused a side effect. If the original wound has not fully closed, follow the wound-care instructions first. Silicone and other scar treatments should not be placed on an open or unhealed area. The Royal Free London guide to hypertrophic and keloid scars describes follow-up and treatment as a course of care, with the clinician reviewing response and side effects.
| Main goal | Options to discuss | Questions that help set expectations |
|---|---|---|
| Reduce itch, tenderness, or firmness | Observation, silicone after the wound closes, or clinician-administered injections depending on the diagnosis and scar. | How long should I try this? What change should I watch for? What symptoms mean I should stop? |
| Reduce raised height | Silicone, pressure therapy in selected cases, injections, cryotherapy, or laser treatment may be discussed. | Which option fits this scar's size, site, age, and diagnosis? How many visits are typical? |
| Improve movement across a joint | Assessment for tightness or contracture; scar therapy, stretching, or a procedure may be considered by a scar or burn team. | Could the scar limit movement further? Would a therapist need to fit or supervise any treatment? |
| Change color or visible texture | Laser or light treatment may be considered for some scars, sometimes alongside another clinician-directed treatment. | What part of the appearance is likely to change, and what pigment or texture changes are possible? |
This is a discussion map rather than a do-it-yourself treatment algorithm. The American Academy of Dermatology's overview of scar treatments notes that raised scars may need a series of treatments, that injections and procedures have potential side effects, and that clinicians may combine treatments. The best next step depends on the actual diagnosis and the outcome you want.
Injections are performed and monitored by a clinician
Intralesional corticosteroid injections place medicine into the raised tissue. A clinician may discuss them to soften or flatten a hypertrophic scar and reduce itch or pain. They often require repeated visits over time. Possible local effects include thinning or atrophy of the skin, visible small blood vessels, or darker or lighter spots. The Royal Free guide describes these pigment and texture changes and provides follow-up instructions after injections.
For some raised scars, a dermatologist may discuss another injected medicine, sometimes in combination with a corticosteroid. The AAD lists 5-fluorouracil (5-FU) and bleomycin among options for raised scars and notes possible redness, swelling, skin thinning, and pigment change. These are prescription procedures delivered into the scar; a topical skincare serum or an over-the-counter "scar gel" is not the same treatment.
Pressure therapy is fitted for selected scars
Pressure garments are most often part of specialist scar or burn care for larger areas. They are measured and fitted so pressure is applied to the scar, and some care plans require wearing them for many hours a day over an extended period. The North Bristol NHS scar-treatment guide describes garments fitted by a therapy team and monitored for fit. This is not a reason to wrap a scar tightly at home: a garment that causes pain or irritation needs review by the team that fitted it, and an improvised tight wrap is not a substitute for a measured garment.
Laser, freezing, and surgery have different targets and trade-offs
Laser or pulsed-dye light may be considered when a clinician wants to address height, color, or symptoms. A dermatologist may combine laser or light with an injection; it can take more than one session, and pigment changes are among the issues to discuss. Cryotherapy freezes scar tissue and may be used for some raised lesions, sometimes in combination with injections. Because skin tone and diagnosis influence risk, ask specifically whether temporary or lasting light or dark marks are possible for your skin.
Some warnings apply to keloids in particular. The AAD's separate keloid treatment guide cautions that cryosurgery can leave a permanent lighter spot on brown or black skin and that keloids often return after removal unless another treatment is planned. Those keloid-specific outcomes should not be treated as a prediction for every hypertrophic scar; they show why confirming the diagnosis matters before choosing a procedure.
Surgical scar revision may be considered when a scar restricts movement or has not responded to other care. Surgery creates a new wound and its own healing period; it does not guarantee that a raised scar will disappear permanently. Ask whether the plan includes follow-up treatment, how recurrence will be monitored, and what recovery will mean for work, exercise, or daily activities.
Skin tone, body site, and personal priorities belong in the plan
People with darker skin can develop hypertrophic scars and keloids, and changes in color after a procedure may be more noticeable. It is reasonable to ask how the clinician's experience, the treatment settings, and the scar's location affect the chance of darker or lighter marks. If the area crosses a joint, rubs against clothing, or affects a piercing or other daily activity, describe that practical impact as well as how the scar looks.
There is no single best treatment for every raised scar, and a treatment that helps one feature may leave another unchanged. A silicone sheet might be convenient for a broad, healed area but awkward at a moving or curved site. An injection may address thickness and itch while carrying a risk of indentation or color change. A procedure may require time away from usual activities. Matching the intervention to the main goal makes it easier to decide whether the likely benefit is worth the visits, discomfort, cost, and uncertainty.
Questions to take to a scar appointment
- Does the mark stay inside the original injury boundary, and what makes this diagnosis more likely?
- What is the first outcome we are trying to improve: height, itch, tenderness, color, or movement?
- Is the skin fully healed for the treatment being proposed?
- How many visits or how many hours of daily use should I expect, and when will we review progress?
- What side effects should I watch for on my skin tone and at this body site?
- If the first approach does not help, what is the next step and how will we decide whether to continue?
These questions can turn a broad request to "make the scar go away" into a practical plan with a measurable goal and a review date. Improvement may mean less itch, softer tissue, easier movement, or a lower profile; complete removal is not a realistic promise. Continue the care plan only as directed and contact the treating clinician if the skin breaks down, becomes increasingly painful, or develops a new reaction.
Practical care while skin heals
While a wound is still open or healing, follow the wound-care instructions from the clinician who treated it. Once the skin has closed, avoid picking, aggressive exfoliation, or unprescribed products that sting or inflame the area. An irritating routine is unlikely to help a sensitive scar.
If rubbing makes a healed scar uncomfortable, soft clothing can reduce friction. Use sun protection on exposed skin according to standard label guidance; it does not flatten scar tissue. Follow your clinician’s advice if the area has specific care instructions.
When to make an appointment
Make an appointment if a raised scar keeps growing, becomes painful or very itchy, pulls over a joint, or interferes with daily movement. It is also reasonable to ask for an examination when you cannot connect the mark to a known injury or cannot tell whether it extends beyond the wound. A clinician can check the diagnosis before you choose a treatment.
Seek prompt medical advice for a mark that is rapidly changing, bleeds without a clear reason, develops an open area, or is not healing. These signs do not prove a serious condition, but they do make an in-person assessment more useful than trial-and-error skincare.
Frequently asked questions
What is the simplest way to tell a hypertrophic scar from a keloid?
A hypertrophic scar stays within the original injury boundary. A keloid can grow beyond it. This is a useful clue, not a home diagnosis; the timing and examination matter too.
Can a hypertrophic scar flatten on its own?
Some hypertrophic scars become flatter or less noticeable over time. The course varies, and improvement is not guaranteed. A clinician can advise whether observation or treatment makes sense for a particular scar.
How long does a hypertrophic scar take to improve?
A raised scar may keep thickening during early healing, then change more slowly. One NHS patient guide says these scars often improve over 12 to 24 months, but that range is not a prediction for an individual.
Do silicone sheets or gels work for every raised scar?
No. Silicone may be discussed after the wound is fully closed, but comparative evidence for hypertrophic scars is uncertain. Ask a clinician whether it fits the scar and how to use it safely.
Can acne leave a hypertrophic scar?
Yes, although raised hypertrophic or keloid scars are less common acne outcomes than flat post-inflammatory color changes or depressed scars. Raised marks after acne deserve assessment if they enlarge, itch, hurt, or cross the original spot.
Will a scar gel flatten a hypertrophic scar?
A product marketed for scar appearance is not the same as a diagnosed-scar treatment plan. The product card on this page links to a topical cosmetic, but it does not establish clinical benefit for hypertrophic scars or replace dermatology care.
When should I have a raised mark checked?
Arrange an assessment if the mark is growing beyond the original wound, has no clear injury history, changes unexpectedly, bleeds or breaks down, becomes painful or very itchy, or limits movement.
Sources and evidence
This guide summarizes general information and does not diagnose an individual mark. Clinical sources were checked on October 1, 2026. Treatment evidence can change as new research is published.
- DermNet. Hypertrophic Scars and Keloids: A Complete Overview.
- American Academy of Dermatology. Scars: Diagnosis and treatment.
- Cochrane. Silicone gel sheeting for treating hypertrophic scars. Evidence search through April 21, 2021.
- Royal Free London. Keloid and hypertrophic scars: a guide.
- DermNet. Acne scarring.
- American Academy of Dermatology. Scars: Signs and symptoms.
- North Bristol NHS Trust. Scar treatment.
- American Academy of Dermatology. Keloids: Diagnosis and treatment.
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