I'm 19. How can I treat the hypertrophic scar on my hand?

Question

Hello doctor,

I have a scar on my hand from self-harming after overwashing my hands for an entire year using low-quality soap. I believed that removing the hard skin would help the scar heal better, but I was wrong. The scar appears to be hypertrophic and is located on my index finger, around the knuckle area.

There is a red line that separates the skin on my knuckle from the rest of my finger. This line looks odd and suggests that the area is detached or elevated compared to the surrounding skin. The natural lines on my knuckles have also become less defined, and there is a brown spot on the scar.

Additionally, I have developed many extra lines and creases on both hands that were not there before, and my skin seems looser overall. Can we improve or fix all of this?

By the way, I am 19 years old, in case that is relevant. I have tried various treatments with little to no success, including Efficort and several topical products that claim to soften the hands. I also have hyperpigmentation on both hands.

Please advise.

Answer 1

Hello,

Welcome to icliniq.com.

I understand how distressing these skin changes can be, especially considering the history of excessive handwashing, use of low-quality soaps, and self-injury. These factors can contribute to skin barrier disruption, inflammation, scarring, and pigmentation changes.

The hypertrophic scar on the index finger knuckle, along with the red line and altered skin texture, suggests that chronic inflammation and mechanical trauma have led to fibrosis and pigmentary alterations. The brown spot, along with the hyperpigmentation on both hands, is likely due to post-inflammatory hyperpigmentation, which is common in individuals who experience repeated irritation or injury.

The looseness of the skin and the presence of extra creases may be a result of chronic dehydration and barrier damage, particularly if topical steroids like Efficort (Hydrocortisone) were used extensively without adequate moisturizing or medical supervision.

For treatment, I recommend discontinuing all irritant products and focusing on restoring the skin barrier. This includes using ceramide-rich moisturizers, fragrance-free emollients, and gentle, non-soap cleansers.

To treat the hypertrophic scar, consider using silicone gel sheets or silicone-based topical scar treatments consistently, as these can help flatten and fade the scar over time. If the scar remains prominent, professional treatments such as corticosteroid injections, laser therapy (fractional carbon dioxide), or microneedling may be effective when performed under a dermatologist’s supervision.

For the pigmentation and excessive creasing, topical agents such as Niacinamide, Azelaic acid, or low-dose retinoids may be beneficial, but they should be introduced cautiously and always paired with regular moisturizing. Sun protection, including for the hands, is essential to prevent further pigmentation changes.

Given your age and the emotional context of these skin issues, it may also be helpful to seek professional support for any underlying compulsive behaviors or psychological distress. Managing these factors can significantly improve both emotional well-being and skin healing over time.

I hope this helps you.

Thank you.