Scars form from inflammation, and from the skin trying to deal with inflammation and infection. As already discussed, enzymes triggered by white blood cells destroy collagen while trying to rescue to affected ruptured follicle. These enzymes, along with other immune reactions, continue to dissolve the tissue, causing depressed or hypotrophic scar-ring.

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One of the eventual responses of the immune system is the acti-vation of fibroblasts (collagen producing cells) in an attempt to repair the damage from the inflammation. The collagen is produced in abundance and unfortunately, in sort of a manic way, trying to repair,  replace, and isolate the damaged areas. This results in “pile-ups” of collagen, resulting in raised or hypertrophic scarring.

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The good news is that many forms of hypertrophic scarring become less prominent with time, as skin enzymes dissolve some of the excess.