A burn scar is an area of fibrous tissue that replaces normal skin following an injury that damages the deeper layers of the dermis. This replacement tissue forms as the body produces an excessive amount of collagen to repair the damaged area. The most common types resulting from burns are hypertrophic scars, which are raised and red but remain within the boundaries of the original wound site. Keloid scars are a more aggressive form that extends beyond the original injury margins and can continue to grow. Understanding scar formation is the first step in minimizing the final appearance of the scar tissue. This guide outlines the layered approach to scar management, starting from the moment of injury through the long-term maturation process.
Preventing Scarring During Acute Wound Healing
Minimizing the initial tissue damage and preventing infection are the primary goals immediately following a burn injury. Proper first aid involves cooling the burn with cool, running water for several minutes to stop the burning process and limit the depth of tissue destruction. Deeper burns that reach the dermis or below are at a much higher risk of problematic scarring and require prompt professional medical assessment.
Once the initial threat is managed, keeping the wound clean is paramount, as infection significantly prolongs the inflammatory phase and increases the likelihood of excessive collagen production. Healthcare providers typically manage the wound with appropriate dressings to prevent bacterial contamination. Maintaining a moist wound environment promotes optimal healing, as excessive dryness can lead to cell death and delay re-epithelialization.
Occlusive dressings are frequently used to maintain this moisture balance while protecting the fragile new tissue from external trauma or friction. Burns that heal in less than 14 days generally have a low risk of problematic scarring, but those that take longer are at a much higher risk. Protecting the wound bed from further injury or tension until it is fully closed is a fundamental step in preventing severe scar formation. This acute phase ends once the skin surface is completely closed, allowing the long-term maturation process to begin.
Self-Administered Techniques for Scar Maturation
Once the burn wound is fully closed and the skin has re-epithelialized, the self-administered phase of scar management begins, focusing on influencing the scar’s maturation process. This maturation phase is lengthy, typically lasting 12 to 18 months, during which the scar tissue is actively remodeling. Scar massage is one of the most effective non-invasive methods, and it should be performed several times daily for up to ten minutes at a time.
Massaging the scar with firm pressure helps to break down the disorganized collagen fibers and improve the pliability of the tissue. The technique involves applying enough pressure to cause the scar to blanch, or turn white, and then moving the tissue in circular, up-and-down, and side-to-side motions. This action helps flatten the scar, improve its flexibility, and reduce common symptoms like pain and itchiness.
Silicone products, available as sheets or topical gels, are considered a primary conservative treatment for raised scars and are applied directly to the healed site. Silicone works by hydrating the stratum corneum, which helps normalize the cell signals that regulate fibroblast activity and collagen synthesis. Consistent application for many hours each day creates a protective barrier that helps to flatten and soften the scar tissue over several months of use.
Regular moisturization is important for maintaining the skin’s barrier function and preventing the scar from becoming dry, which can increase itching and irritation. Simple, unperfumed moisturizers should be applied multiple times daily, often in conjunction with the massage technique. Protecting the developing scar from the sun is necessary, as new scar tissue is highly sensitive to ultraviolet (UV) radiation. Exposure to UV rays can lead to hyperpigmentation, causing the scar to darken and become more noticeable, so using a broad-spectrum sunscreen or keeping the area covered is highly recommended.
Advanced Medical Options for Existing Scars
For severe, established hypertrophic and keloid scars, several advanced medical interventions are available. Injectable treatments are often used for raised scars, with corticosteroids being the most common agent, injected directly into the scar tissue. Steroids reduce inflammation and suppress excessive collagen production, which helps to flatten and soften the scar.
Pressure garment therapy is a mechanical intervention often prescribed by burn specialists for patients with extensive or deep burns. These custom-fitted elastic garments apply continuous, graded pressure to the scar tissue, typically worn for up to 23 hours a day for many months. The constant pressure helps align the newly forming collagen fibers in a more organized pattern, effectively preventing and reducing the thickness of hypertrophic scars.
Resurfacing techniques, such as laser therapy, can significantly improve the texture and color of mature burn scars. Pulsed dye lasers target the blood vessels in red, raised scars to reduce redness and thickness. Fractional ablative lasers create microscopic channels in the scar tissue to stimulate collagen remodeling and improve skin texture. Multiple sessions are typically required, and these treatments are often combined with other therapies.
Finally, surgical revision may be necessary to address functionally limiting contracture scars, which tighten the skin and restrict movement, often near joints. Techniques include excision, where the scar tissue is removed, and Z-plasty, a procedure that involves making a Z-shaped incision to rearrange skin flaps and release the tension. Skin grafting or tissue expansion may also be utilized to replace or stretch healthy skin over the affected area, aiming to restore both function and a more natural appearance.