II. Epidemiology

  1. Occurs in any race with any skin type (although occurs more commonly in darker skin)
    1. Contrast with Keloids which are far more common in darker skin
  2. Hypertrophic Scar has no genetic predisposition
    1. Contrast with Keloids

III. Pathophysiology

  1. Excessive fibroproliferative Collagen response to inflammation within the reticular Dermis
    1. Results in a scar formed from disorganized extracellular matrix
    2. More common in Trauma to skin in high tension regions
      1. Common skin injuries include Burn Injury, Lacerations, piercings, surgery
  2. Stages
    1. Stage 1: Inflammation occurs for up to first 10 days (with onset within 1 month of injury)
    2. Stage 2: Proliferation occurs over next 14 days
    3. Stage 3: Maturation and remodeling may continue for years

IV. Symptoms

  1. Lesions may cause local discomfort or Pruritus

V. Signs

  1. Characteristics
    1. Slightly raised or flat, pink to red lesions
  2. Isolated to site of Skin Injury
    1. Contrast with Keloid which extends beyond the scar
  3. Distribution
    1. Can occur anywhere, but have a predilection for extensor surfaces
  4. Timing
    1. Onset within 1 month of wound and regress and flatten with time

VI. Labs

  1. Biopsy Findings (if biopsied for other reasons)
    1. Fibroblasts increased
    2. Collagen fiber density increased

VII. Course

  1. Spontaneous regression over time as dermal irritation resolves

VIII. Management

IX. Prevention

  1. See Keloid

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