Painful Raised Scar After an Injury? How Steroid Injections Can Help Hypertrophic Scars
By: Dr. Caroline Vaughn
Not every scar heals flat. After an injury or surgery, some scars become thick, raised, itchy, or even painful. These are known as hypertrophic scars, and while they are not dangerous, they can be uncomfortable and cosmetically bothersome.
Recently, a 58-year-old woman visited our dermatology clinic with a raised scar on her left shoulder that developed after a fall approximately nine months earlier. During the same visit, she also sought treatment for persistent flaky, irritated ears that had stopped responding to her previous eczema medication.
After a comprehensive evaluation, our board-certified dermatologist diagnosed a hypertrophic scar and seborrheic dermatitis, creating a personalized treatment plan to address both conditions.
If you're looking for expert scar treatment or help with chronic flaky ears in Houston or Katy, Texas, here's what you should know.
The Patient's Story
Nine months after a fall, this patient continued to have a thickened scar on the front of her left shoulder.
Although the scar was stable, she wanted to know whether it could be softened and made less noticeable.
She also reported:
Burning skin inside the ears
Flaking
Pain
Occasional bleeding
She had previously been using mometasone cream, but it was no longer providing adequate relief.
Following examination with dermoscopy, two separate diagnoses were made:
Hypertrophic scar on the left shoulder
Seborrheic dermatitis involving the ears
What Is a Hypertrophic Scar?
A hypertrophic scar develops when the body produces too much collagen during wound healing.
Unlike a normal scar, it becomes:
Raised
Thickened
Firm
Sometimes itchy
Occasionally painful or tender
Unlike keloids, hypertrophic scars remain confined to the original area of injury and do not grow beyond the wound's borders.
These scars commonly develop after:
Falls
Surgical incisions
Burns
Cuts
Traumatic injuries
Can a Hypertrophic Scar Be Removed Completely?
This is one of the most common questions dermatologists hear.
Unfortunately, no treatment can completely erase a scar.
However, several therapies can significantly improve:
Thickness
Firmness
Itching
Tenderness
Overall appearance
The goal is to make the scar flatter, softer, and less symptomatic.
Intralesional Kenalog (ILK): A Proven Scar Treatment
After discussing available options, the patient chose to proceed with an intralesional Kenalog (ILK) injection.
Kenalog is a corticosteroid injected directly into the scar to help:
Flatten thickened scar tissue
Reduce excess collagen production
Improve itching and discomfort
Soften the scar over time
For this visit:
One hypertrophic scar was treated.
Kenalog 20 mg/mL was injected.
A total of 0.1 mL was administered.
Before treatment, the potential risk of skin thinning (atrophy) was reviewed, as this is a known but generally uncommon side effect when injections are performed appropriately.
Many patients require multiple treatment sessions to achieve the best cosmetic outcome.
Silicone Scar Sheets: An Important At-Home Treatment
In addition to the steroid injection, the patient was advised to use silicone scar sheets.
Silicone therapy is one of the most widely recommended non-invasive treatments for hypertrophic scars and may help:
Flatten raised scars
Improve scar texture
Decrease redness
Reduce itching
When used consistently over several months, silicone sheets can enhance the results of in-office treatments.
Why Were the Flaky Ears Diagnosed as Seborrheic Dermatitis?
The patient's ear symptoms had initially been treated as eczema, but the examination was more consistent with seborrheic dermatitis, a chronic inflammatory skin condition.
Seborrheic dermatitis commonly affects areas rich in oil glands, including:
The scalp
The eyebrows
Around the nose
Behind and inside the ears
Symptoms often include:
Flaking
Redness
Burning
Itching
Crusting
The condition tends to flare periodically and requires ongoing management.
Why Was Her Medication Changed?
Because mometasone cream was no longer adequately controlling her symptoms, her dermatologist recommended switching to:
Fluocinonide 0.05% topical solution
The liquid formulation is often easier to apply around and inside the ears than a cream and can provide better penetration in areas with hair or narrow skin folds.
She was instructed to:
Apply it twice daily during flares
Limit use to 14 days per month
Contact the office if she preferred a cream formulation instead
Managing Seborrheic Dermatitis at Home
In addition to prescription medication, patients with seborrheic dermatitis often benefit from:
Regular use of fragrance-free moisturizers
Medicated shampoos containing zinc pyrithione, selenium sulfide, or coal tar (when appropriate)
Avoiding excessive scratching
Managing stress, which may trigger flare-ups
Although seborrheic dermatitis is chronic, consistent treatment can greatly reduce symptoms and improve quality of life.
Dermatology Care for Scars and Seborrheic Dermatitis in Houston and Katy, Texas
Whether you're dealing with a raised scar after an injury or chronic flaky, irritated ears, a proper diagnosis can lead to more effective treatment. From intralesional steroid injections to customized therapies for seborrheic dermatitis, early intervention can improve both comfort and cosmetic outcomes.
At Village Dermatology, our board-certified dermatologists provide expert care for hypertrophic scars, keloids, seborrheic dermatitis, eczema, and other chronic skin conditions. We proudly serve patients throughout Houston and Katy, Texas with personalized treatment plans designed to help them look and feel their best.
If you have a raised scar or persistent flaky ears that aren't improving, schedule an appointment with Village Dermatology for a comprehensive evaluation.
