It is not possible to entirely erase a burn scar, but treatment can significantly reduce its visibility and improve its texture and function. A burn scar is the body’s natural response to a deep tissue injury, where normal skin is replaced by fibrous tissue. The goal of modern scar management is to promote the reorganization of that collagen to make the scar flatter, softer, and more closely match the surrounding skin. This process often combines conservative home care with professional medical procedures. The best treatment path depends on the scar’s type, location, and maturity.
Understanding Different Types of Burn Scars
Burn injuries can result in several types of scars. The most common is the hypertrophic scar, characterized by an overgrowth of dense, fibrous tissue confined strictly to the original wound site. These scars appear raised, red, and feel firm, typically developing within weeks of the initial injury.
A keloid scar extends beyond the boundaries of the original burn wound. Keloids rarely regress naturally and continue growing over time, often requiring intensive treatment. Both hypertrophic and keloid scars result from an excessive production of collagen.
A contracture scar is a concern when a burn occurs over a joint or mobile area like the neck or armpit. This scar involves the tightening of skin and underlying tissues, which restricts the normal range of motion and causes functional impairment. This shortening occurs due to specialized cells called myofibroblasts, which pull the wound edges together.
The less common atrophic scar presents as a depressed or sunken area below the level of the surrounding skin. This appearance is caused by a loss of underlying tissue or a failure to adequately regenerate tissue during initial healing.
Non-Surgical and Conservative Scar Management
The first line of defense against abnormal scar formation involves conservative, non-invasive therapies used during the scar maturation phase. Silicone therapy, available as self-adhesive sheets and topical gels, is a recommended treatment for hypertrophic and keloid scars. It works by creating a semi-occlusive barrier over the scar, which increases hydration of the stratum corneum, the outermost layer of the skin.
This sustained hydration helps regulate the overactive cells responsible for excessive collagen production, leading to a softer, flatter, and less noticeable scar over time. To be effective, silicone products must be worn consistently, often for 12 hours a day or more, for several months.
Customized pressure garments are another standard conservative approach, particularly for managing large burn scars. These elastic garments apply continuous, graded pressure to the healing area. The sustained compression reduces blood flow and oxygen supply to the scar tissue, which decreases the synthesis of new collagen and encourages the breakdown of existing scar tissue.
Manual scar massage is a beneficial technique often incorporated into a daily routine. Applying firm, circular pressure helps to physically break down the haphazardly organized collagen fibers within the scar matrix. This mechanical manipulation promotes the realignment of collagen, increasing the scar’s pliability and elasticity, and helping to soften the tissue.
Advanced Minimally Invasive Treatments
When conservative management is insufficient, procedures can be employed to remodel the scar tissue. Laser therapy is one of the most effective advanced treatments, utilizing different wavelengths to target specific scar characteristics. Pulsed dye lasers (PDL) target the blood vessels within the scar, which effectively reduces the persistent redness and vascularity common in immature or hypertrophic scars.
Ablative fractional lasers, such as the fractional carbon dioxide (CO2) laser, create thousands of microscopic channels in the scar tissue while leaving the surrounding skin intact. This controlled injury stimulates the body’s natural wound healing response, leading to the reorganization of collagen and elastin, which improves the scar’s texture, thickness, and flexibility. Laser treatments are often combined with topical steroid application immediately after the procedure to enhance the drug’s penetration into the dense scar tissue.
Intralesional injections, typically using corticosteroids, are a mainstay for treating raised, thickened scars like hypertrophic scars and keloids. The corticosteroid is injected directly into the scar tissue, where it works by reducing inflammation, inhibiting fibroblast activity, and breaking down collagen. These injections are typically repeated every four to eight weeks until the scar begins to flatten and soften.
For atrophic or depressed scars, procedures that restore volume are often the most appropriate intervention. Dermal fillers or fat grafting can be used to raise the sunken scar tissue, making the surface smoother and more continuous with the surrounding skin. Microneedling, which involves creating tiny punctures, is also used to stimulate the production of new collagen, helping to fill in surface irregularities and improve the overall texture of the scar.
Surgical Options for Severe Scars
Surgery is reserved for mature, severe burn scars that have not responded to less invasive methods, particularly those causing significant functional impairment. Scar excision and revision involves surgically removing the entire scar and closing the wound using specialized techniques. The goal is to replace a wide, noticeable scar with a thinner, less conspicuous line oriented along the natural tension lines of the skin.
For large areas of severe scarring or unstable wounds, skin grafting may be necessary to replace the damaged tissue. This involves transferring healthy skin from a donor site to cover the excised scar area. Grafts are often preferred for critical areas to minimize the risk of post-operative contracture.
Specific techniques address contracture scars that limit joint mobility. Z-plasty involves making a Z-shaped incision to surgically lengthen the scar and reorient its direction, releasing tension. W-plasty uses a series of small, interlocking triangular flaps to break up a linear scar into a less noticeable, irregular line.
Tissue expansion offers an alternative to traditional grafting by stretching healthy skin adjacent to the scar. A silicone balloon expander is placed under the healthy skin and gradually inflated with saline over several weeks, causing the skin to grow. Once sufficient excess skin is created, the scar is removed, and the newly stretched, healthy skin is used to cover the defect, providing an excellent match in color and texture.