Understanding Hypertrophic & Keloid Scars: A Comprehensive Guide

Hypertrophic and Keloid scars are variations to the scars formed in the natural healing process. They are natural and formed in a response to an injury

Aug 2023

Table of contents

Introduction to Hypertrophic and Keloid Scars

Hypertrophic and Keloid scars are variations of the scars that develop during the natural healing process. Scars are a body's natural response to injuries, and understanding their formation and management can help ensure optimal recovery.

The Phases of Scar Formation

Scars mature through a series of stages, each vital to the wound healing process.

The Inflammatory Phase (0-7 days)

During the initial inflammatory phase (0-7 days) of healing, tissues are primarily held together by sutures, screws, wires, plates, or external support. The body releases a multitude of chemicals to start the healing process. It's crucial to stabilise the wound in this phase to reduce scarring.

The Repair Proliferation Phase

As the scar transitions from red to pink and the sutures are successfully removed, with the skin holding together well and a significant reduction in pain, the tissue enters the repair phase of healing. During this phase, collagen, which gives the scar its structure, begins to mature with fibres laid down in random orientations. Cells proliferate, new blood vessels emerge (angiogenesis), and repair chemicals play a predominant role.

Re-modelling Maturation Phase

When the swelling diminishes and the scar becomes pink and malleable, the tissue advances to the remodelling phase of healing. In this stage, intermolecular cross-linking between collagen fibres takes place, bolstering the tissue's tensile strength. As the weaker collagen is supplanted by its stronger counterpart, therapeutic attention shifts towards collagen alignment and tissue differentiation. This emphasis on therapy involves increased resistance and repetitive force. Typically, this phase initiates around six weeks post-injury and can extend up to 18 months, especially when nerve repairs are concerned.

Stages of Skin Healing - Formation of Hypertrophic Scaring (Shirakami, et al.,2020)

Identifying Hypertrophic and Keloid Scars

Monitoring your scars is essential as early intervention can minimise their severity. Both hypertrophic and keloid scars arise from increased collagen production and reduced scar breakdown chemicals, leading to excessive scar formation. Their formation often has a genetic component.

Hypertrophic Scars

  • Red, raised, and thicker than a usual scar
  • Red or pink in colour
  • Occurs in tight skin areas
  • Collagen fibres have a more organised orientation
  • Easier to treat early on
  • Typically develops within one-two months post-injury and then stabilises
Picture of Hypertrophic Scar

Keloid Scars

  • Thick scars that spread beyond the initial wound's area in height and width
  • Purple or darker in colour
  • Can appear on any body part
  • Collagen fibres have a random orientation
  • More challenging to treat
  • Can continue to develop years after the initial injury
Picture of Keloid Scar

Symptoms Associated with Keloid or Hypertrophic Scars

Individuals with these scars might experience:

  • Increased sensitivity over the scar line
  • Raised and tight skin
  • Pain
  • Redness
  • Swelling

Management and Treatment Recommendations

Depending on the scar's location and the initial injury, treatments can vary.

Suggested Treatments

  • Desensitisation of the scar
  • Scar massage
  • Stretches
  • Mobilisation exercises
  • Splinting
  • Coban application
  • Application of silicone products

After your appointment at The Hands Physio, you will also receive guidance on managing your scar at home.

Caring for Silicone Applications

  • Clean the skin area before applying silicone
  • Check the scar an hour post-application to ensure no reactions
  • Keep the silicone out of sunlight
  • Clean silicone with warm, soapy water

By following a hand therapist's recommendations, you should see a visible reduction in the scar's redness, sensitivity, and hardness. While scar management might be needed for up to three months, complete maturation can take between one to two years.


Scars are a natural part of the healing process, but with the right knowledge and intervention, their appearance and associated discomfort can be significantly reduced. For further information and treatment options, please contact us.

Share this guide:

See All Injuries