Background: Hypertrophic scars are a common sequela of cutaneous injury and can cause significant functional and psychosocial morbidity. Although surgical excision offers rapid removal of scar tissue, recurrence rates remain high if not combined with adjuvant therapy. Intralesional corticosteroids, particularly triamcinolone acetonide, have been widely used due to their ability to inhibit fibroblast proliferation and collagen deposition. This study aimed to compare the efficacy, recurrence rates, patient-reported outcomes, and safety profile of intralesional triamcinolone versus surgical excision in the management of hypertrophic scars.

Methods: A prospective, comparative study was conducted on 136 patients with hypertrophic scars, randomized into two groups: Group A (n = 68) received intralesional triamcinolone (40 mg/mL) every 3 weeks for 12 weeks, and Group B (n = 68) underwent surgical excision with primary closure. Baseline demographic and clinical parameters were recorded. Outcomes were assessed at baseline and 12 weeks using the Vancouver Scar Scale (VSS), visual analog scale (VAS) for pain and pruritus, recurrence rates, adverse events, and patient-reported global response and satisfaction. Statistical analysis was performed using independent t-tests and chi-square tests, with p < 0.05 considered significant.

Results: Baseline characteristics, including mean age (32.4 ± 9.8 vs. 33.1 ± 10.2 years) and mean VSS scores (8.0 ± 1.8 vs. 8.0 ± 1.9), were comparable between groups. At 12 weeks, Group A demonstrated significantly lower mean total VSS scores than Group B (3.2 ± 1.5 vs. 3.8 ± 1.7, p = 0.031), with greater improvement in pigmentation and pliability. Pruritus relief was significantly better with triamcinolone (VAS 1.2 ± 0.8 vs. 1.8 ± 1.0, p = 0.002). Recurrence was significantly lower in Group A (10.3%) compared to Group B (20.6%, p = 0.048). Skin atrophy occurred in 11.8% of patients receiving triamcinolone, whereas surgical patients experienced more wound-related complications. Patient satisfaction was higher in the triamcinolone group (70.6% vs. 63.2%), though not statistically significant.

Conclusion: Intralesional triamcinolone provides superior overall scar remodeling, lower recurrence rates, and better pruritus relief compared with surgical excision, with manageable local adverse effects. It represents an effective, minimally invasive, office-based treatment for hypertrophic scars and should be considered as a first-line option, especially for non-refractory lesions.