Hypertrophic Scar, Wound Contraction and Hyper-Hypopigmentation

For decades, hypertrophic scarring, contraction, and pigment abnormalities have altered the future for children and adults after thermal injury. The hard, raised, red and itchy scars; shrunken wounds; and hyper- and hypo-pigmented scars are devastating to physical and psychosocial outcomes. The specific causes remain essentially unknown and, at present, prevention and treatment are symptomatic and marginal at best. Hypertrophic scarring is the major significant negative outcome after survival from of a thermal injury. Hypertrophic scars are hard, raised, red, itchy, tender, and contracted.1,2 These scars are ugly, disfiguring, and uncomfortable and may diminish, but never totally go away. Hypertrophic scarring after deep partial-thickness wounds is common. We have reviewed the English literature on the prevalence of hypertrophic scarring3 and found that children, young adults, and people with darker, more pigmented skin are particularly vulnerable and, in this subpopulation, the prevalence is up to 75%.4,–6 Hypertrophic scarring is devastating and can result in disfigurement and scarring that affects quality of life which, in turn, can lead to lowered self esteem, social isolation, prejudicial societal reactions, and job discrimination.7,–12 Scarring also has profound rehabilitation consequences, including loss of function, impairment, disability, and difficulties pursuing recreational and vocational pursuits.10,13,14