L91.0 Hypertrophic scar

Name of the Condition

• Hypertrophic scar

Summary

Hypertrophic scars are raised, thickened areas of skin that form during the healing process of a wound. They result from an overproduction of collagen at the site of injury, leading to a firm, raised texture that remains within the boundaries of the original wound. These scars differ from keloids, which extend beyond the wound site, and are common after surgery, burns, or trauma.

Causes

Hypertrophic scars develop due to abnormal wound healing, where the body produces excess collagen in response to tissue damage. This overproduction is often triggered by factors such as inflammation, infection, or prolonged healing. Surgical incisions, burns, or injuries that disrupt the skin’s normal repair process are typical causes.

Risk Factors

• Wound location: Areas under tension (e.g., joints, chest) are more prone to hypertrophic scarring.
• Infection or prolonged inflammation at the wound site.
• Genetic predisposition to abnormal scarring.
• Delayed or improper wound care.
• Repeated trauma to the healing area.

Symptoms

• Raised, firm, and thickened skin at the wound site.
• Red or pink discoloration that may fade over time.
• Mild to moderate itching or discomfort.
• The scar remains within the original wound boundaries, distinguishing it from keloids.

Diagnosis

Diagnosis is typically made through a physical examination of the scar. Healthcare providers assess its appearance, texture, and location to confirm it is a hypertrophic scar rather than a keloid or other condition. No specific tests are usually required, but a history of the original injury or surgery is considered.

Treatment Options

• Topical treatments: Silicone gel sheets or silicone-based creams may reduce scar thickness and improve appearance.
• Injections: Corticosteroid injections can flatten and soften the scar.
• Laser therapy: Helps reduce redness and improve texture.
• Pressure therapy: Applied via garments or dressings to flatten scars, especially after burns.
• Surgical revision: Considered for severe or symptomatic scars, though recurrence is possible.

Prognosis and Follow-Up

Hypertrophic scars often improve over time, with many becoming flatter and less noticeable within 1–2 years. However, they may persist or require intervention if symptomatic. Follow-up with a healthcare provider is recommended to monitor changes and adjust treatment as needed.

Complications

• Persistent itching or discomfort.
• Cosmetic concerns due to visible scarring.
• Limited mobility if the scar is over a joint.
• Psychological impact from appearance.

Lifestyle & Prevention

• Proper wound care: Keep wounds clean and covered to prevent infection.
• Avoid smoking, which can impair healing.
• Protect scars from sun exposure to prevent darkening.
• Use gentle skincare and avoid picking at healing wounds.

When to Seek Professional Help

Consult a healthcare provider if the scar is painful, itchy, growing rapidly, or affecting movement. Seek care if signs of infection (e.g., redness, pus) develop or if the scar does not improve over time.

Tips for Medical Coders

Use code L91.0 for hypertrophic scars. Document the scar’s location, cause (e.g., post-surgical, post-traumatic), and any associated symptoms or treatments. Ensure the scar is distinguished from keloids, as coding differs. Include details about wound history and any interventions performed.