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Following injury, tissue repair involves inflammation, granulation tissue proliferation and scar formation. Predisposed individuals may have an imbalance in collagen production and maturation. Scars may be hypertrophic, normal or atrophic. Hypertrophic scars and keloids are characterised by an overgrowth of dense fibrous tissue. Hypertrophic scars and keloids usually follow an initiating trauma or surgery. We present a case of spontaneous stellate hypertrophic scar formation on the knuckles of a 14-year-old boy. Scar tissue formation was confirmed after histopathological assessments. There was no history of initiating trauma or other possible triggering factors. To date, this type of spontaneous hypertrophic scar formation has not been reported.