A 25-year-old patient develops a 3 cm hypertrophic scar 8 months after an abdominal surgical incision. On examination, the scar is raised, erythematous, and pruritic but confined within the original wound boundaries. The management of choice for a symptomatic hypertrophic scar is:

• A Surgical excision with wider margins
• B Intralesional corticosteroid injection (triamcinolone) ✓
• C Radiation therapy
• D CO2 laser ablation as first line

Explanation

Hypertrophic scars (confined within wound margins) are distinguished from keloids (extend beyond wound margins). First-line treatment for symptomatic hypertrophic scars is intralesional triamcinolone acetonide injection (10–40 mg/mL every 4–6 weeks), which reduces collagen synthesis and fibroblast proliferation, achieving 50–80% improvement. Silicone sheeting is an adjunct for prevention. Surgical revision alone risks recurrence; radiation is reserved for keloids refractory to other treatments.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.