Hypertrophic scars: Pathophysiology, risk factors, and contemporary non-surgical management

Research objective: The objective of this study was to summarize current knowledge on the pathophysiological mechanisms underlying hypertrophic scar formation and to review contemporary non-surgical management strategies aimed at improving clinical outcomes. Methodology: A narrative literature review was conducted using the PubMed database, focusing on studies addressing the pathophysiology, epidemiology, risk factors, and non-surgical treatment modalities of hypertrophic scars. Priority was given to randomized controlled trials, cohort studies, and recent high-quality review articles. Main conclusions: Hypertrophic scar formation is driven by prolonged inflammation, dysregulated fibroblast-to-myofibroblast differentiation, and excessive activation of profibrotic signaling pathways, particularly TGF-β. Evidence indicates that multimodal treatment approaches tailored to scar stage and individual patient characteristics provide the most effective therapeutic outcomes. However, there remains a lack of robust long-term comparative data. Application of the study: The findings may support clinicians in selecting evidence-based, individualized therapeutic strategies for hypertrophic scars and highlight the importance of combining conservative and minimally invasive treatments in routine clinical practice. Originality/Novelty of the study: This work provides an integrated synthesis of current molecular mechanisms and non-surgical treatment options for hypertrophic scars, emphasizing the need for personalized, stage-dependent multimodal therapy and identifying gaps for future randomized clinical research.