Why Some People Get Hypertrophic Acne Scars (And How to Treat Them Safely)

Some scars don’t just fade over time. They grow, thicken, and stay.

Hypertrophic acne scars are raised, often red, and surprisingly stubborn. They are not just leftover marks but signs of an overactive healing process.

When inflammation runs too high for too long, the skin produces too much collagen, creating a scar that sits above the surface. But not everyone scars this way.

So what makes the difference? In this post, we will explore why hypertrophic scars form, who is most at risk, and how to treat them safely without triggering more damage.

The Role of Inflammation in Scarring

Inflammation is the body’s natural response to injury, including acne.

It starts the healing process by sending immune cells to the site of damage. But when inflammation lingers, it does more harm than good.

Prolonged inflammation overstimulates fibroblasts, the cells responsible for producing collagen.

Instead of rebuilding skin evenly, the body deposits thick bundles of collagen in one area, forming a raised scar. The longer the skin stays inflamed, the more likely it is to overcorrect.

This is why early intervention and inflammation control are key when treating active acne and preventing hypertrophic scars from developing.

Why Collagen Excess Creates Raised Scars

Collagen plays a critical role in skin healing. It gives structure, strength, and elasticity.

But when the skin produces too much of it in response to inflammation or trauma, that helpful process becomes a problem.

In hypertrophic acne scars, the body creates collagen faster than it can break it down, and instead of laying it neatly, it stacks fibres in thick, tangled bundles. This leads to a firm, raised scar that stays visible long after the acne has healed.

Here’s how excess collagen contributes to raised scars:

• Overproduction: Fibroblasts go into overdrive, producing collagen rapidly.
• Disorganised structure: Fibres are layered unevenly, lacking proper alignment.
• Impaired breakdown: The body fails to remove surplus collagen effectively.

The result is a scar that feels tight, appears elevated, and often resists fading without intervention.

Who Is Most at Risk of Hypertrophic Scars

Some people are simply more prone to hypertrophic scarring, due to a mix of biology, age, skin type, and behaviour. These risk factors help explain why two people with similar acne can heal so differently.

Family History

If your parents or siblings develop raised or keloid scars, you likely carry the same genetic traits. These genes influence how your body handles inflammation and collagen production.

Even with mild acne, genetically prone individuals can develop thick, raised scars. Family history is one of the strongest predictors of how your skin will heal after trauma or breakouts.

Darker Skin Tones

People with darker skin tones (Fitzpatrick types IV to VI) tend to produce more melanin and often respond to skin injury with stronger inflammation.

This can lead to an overactive healing process, with excess collagen forming as the skin tries to protect itself. Raised scarring is more common in these skin types, especially after deep or inflamed acne.

Younger Age

Younger individuals, particularly those under 30, have faster cell turnover and a more vigorous healing response. While this helps wounds close quickly, it also increases the risk of collagen overproduction.

The same biological drive that makes younger skin resilient can lead to hypertrophic scarring when the body heals too aggressively, especially after cystic or inflamed acne.

Severe Acne

When acne penetrates deeply into the skin and causes swelling, tissue damage becomes more extensive. Cystic or nodular acne often triggers prolonged inflammation, making the skin more prone to forming thick, raised scars during healing.

The more trauma the skin endures, the more likely it is to deposit excess collagen in an attempt to rebuild.

Picking or Delayed Care

Picking, squeezing, or delaying treatment worsens inflammation and disrupts natural healing. Each time a lesion is disturbed, the skin reactivates its repair cycle, increasing the risk of abnormal scar tissue forming.

Even mild acne can result in hypertrophic scars if it’s frequently irritated or left untreated for too long during its inflammatory phase.

6 Evidence-Based Treatment Approaches

Treating hypertrophic acne scars requires more than just flattening the surface. It involves calming inflammation, regulating collagen production, and supporting proper skin regeneration.

Fortunately, several treatments have been clinically proven to reduce raised scarring safely and effectively.

1. Silicone Gel or Sheets

Silicone is a first-line treatment for hypertrophic scars. Applied consistently, it helps flatten the scar by hydrating the skin and regulating collagen synthesis. It’s safe for most skin types and works best when started early.

2. Intralesional Steroid Injections

Corticosteroids like triamcinolone are injected directly into the raised scar. These reduce inflammation and soften excess collagen. Multiple sessions are usually needed, spaced weeks apart, and are often combined with other treatments for optimal results.

3. Laser Therapy

Pulsed dye lasers (PDL) and fractional ablative lasers target both the vascular and textural aspects of raised scars. Lasers help remodel the collagen network, reduce redness, and improve overall skin texture. Downtime and results vary depending on the device used.

4. Microneedling with Steroids or PRP

Microneedling physically breaks down dense scar tissue while stimulating collagen remodelling. When paired with topical corticosteroids or platelet-rich plasma (PRP), it enhances penetration and healing, especially in early-stage hypertrophic scars.

5. Cryotherapy

This method freezes the scar tissue using liquid nitrogen, causing it to shrink over time. It’s more commonly used for smaller hypertrophic scars or in combination with steroid injections.

6. Preventive Protocols for High-Risk Patients

Those with a history of hypertrophic acne scars can benefit from early, targeted treatment to prevent long-term raised scarring. This may include post-acne anti-inflammatory care, topical silicone, or preventive laser sessions shortly after lesions heal.

Every scar responds differently. The best outcomes often come from combining therapies and personalising the approach based on skin type, scar maturity, and medical history.

How to Maintain Results After Treatment

Treating hypertrophic acne scars is only half the journey. Once the scar has flattened or softened, the focus shifts to preventing it from returning.

Maintenance is crucial because raised scars can regrow if the underlying triggers, like inflammation or trauma, resurface.

These ongoing strategies help protect your results and support long-term skin health:

• Protect the skin from UV exposure - Sun damage increases pigmentation and inflammation, making scars more noticeable. Use a broad-spectrum sunscreen daily, especially after laser or microneedling treatments. UV protection helps scars fade more evenly and reduces the risk of recurrence.
• Avoid skin trauma and picking - Even after treatment, disturbing healing areas can re-trigger the scar response. Avoid squeezing pimples, scratching healing skin, or using harsh exfoliants. Treat active acne gently to minimise new scarring.
• Use topical treatments consistently- Products like silicone gels, retinoids, or mild steroids (if prescribed) help remodel collagen and prevent raised regrowth. Consistency matters. Stopping too soon can undo progress.
• Follow up with your practitioner - Periodic reviews allow for early detection of any scar reactivation. In some cases, a touch-up treatment or maintenance injection may be needed to keep scars from reforming.
• Support skin health with lifestyle habits - Sleep, stress, hydration, and nutrition all affect skin repair. Support your results with a routine that encourages balanced inflammation and strong barrier function.

Conclusion

Hypertrophic acne scars are challenging, but with the right treatment and care, they can improve.

Understanding what causes these scars allows for earlier, more effective intervention. Options like steroid injections, silicone gels, and laser therapy work best when combined with consistent aftercare and healthy habits.

Preventing scars from returning is just as important as treating them. With a tailored approach and ongoing support, long-term results are within reach.

Raised scars do not have to be permanent. They can fade with time, patience, and a strategy that supports healing from the inside out.