Background: Pathologic scars present a difficult management problem for physician searching for optimal therapeutic approach. Objective: To compare the clinical response of hypertrophic scars after treatment with intralesional steroid injection combined with silicone sheet versus silicone sheet alone. Materials and Methods: The study was a randomized, prospective study. Twenty patients were treated with intralesional injection triamcinolone acetonide by dermojet combined with silicone sheet, and ten patients were treated with silicone sheet alone. The response of treatment was evaluated by the Vancouver scar scale (vascularity, pigmentation and thickness) with the improvement of symptoms (pain and/or pruritus) and ultrasonography to measure scar tissue thickness. Results: patients who treated with intralesional triamcinolone acetonide combined with silicone sheet showed an improvement regarding symptoms(pain and/or pruritus), also they showed an improvement according to Vancouver scar scale (vascularity, pigmentation and thickness) and ultrasonographic assessment showed marked decrease in scar thickness, but patients who treated with silicone sheet alone showed an improvement regarding symptoms, Vancouver scar scale and ultrasonographic assessment but less than first group. Conclusion: This study shows that combination therapy within tralesional triamcinolone acetonide injection 40mg/ml with silicone sheet appears to be superior to treatment by silicone sheet alone in the treatment of hypertrophic scars with no significant side effects.