Burn scars form when skin is damaged by heat, chemicals, electricity, or radiation, causing skin cells to die. The body then produces collagen to repair the injured area, leading to the formation of scar tissue. While minor burns may heal without lasting marks, deeper burns often result in permanent scarring that can impact appearance, cause discomfort, or limit movement. Understanding the different types of burn scars and available treatment options is a step towards improving both the physical and functional aspects of these scars.
Types of Burn Scars
Burn injuries can lead to several distinct types of scars, each with unique characteristics. Recognizing these differences is important for determining suitable treatment approaches.
Hypertrophic scars are raised and develop within the original wound boundaries from an overproduction of collagen during healing.
Keloid scars are raised, extending beyond the original wound margins. They can grow for months or years. These scars result from an overgrowth of collagen and are more common in individuals with darker skin tones or a genetic predisposition.
Atrophic scars appear as sunken or indented areas on the skin. This occurs due to a loss of underlying tissue, preventing the skin from regenerating to its normal level.
Contracture scars involve a tightening of the skin, which can restrict movement. These scars form as healing skin pulls together.
At-Home and Over-the-Counter Options
Several at-home and over-the-counter strategies can help manage burn scars. Silicone sheets and gels hydrate scar tissue and regulate collagen production. Consistent application over several months is advised.
Regular scar massage helps break down collagen fibers, improve circulation, and increase pliability. Apply gentle, circular motions multiple times daily for a softer, flatter scar. Frequent moisturizing maintains skin hydration, preventing dryness and discomfort.
Sun protection is important for new scars to prevent hyperpigmentation. Apply broad-spectrum sunscreen with SPF 30+ to the scarred area, or cover it with protective clothing. These practices improve long-term outcomes.
Clinical Procedures
When at-home methods are insufficient, various clinical procedures can address burn scars. Corticosteroid injections into the scar tissue reduce inflammation and break down excess collagen to flatten and soften hypertrophic and keloid scars. These injections are administered in a series over weeks or months.
Laser therapy uses different types of lasers for scar concerns. Pulsed dye lasers reduce redness and improve texture. Fractional lasers create microscopic channels to stimulate new collagen and remodel existing scar tissue, improving texture and pigmentation.
Microneedling uses a device with fine needles to create controlled micro-injuries in the scar, prompting healing and increasing collagen and elastin production, improving scar texture and depth. Dermabrasion uses a rapidly rotating device to remove outer skin layers, smoothing uneven scar surfaces and improving overall skin texture.
Pressure garments apply constant pressure to the scarred area to flatten and prevent excessive scar tissue growth. They reduce blood flow and oxygen to the scar. Often used with other therapies, pressure garments optimize scar outcomes.
Surgical Interventions
Surgical interventions are considered for severe or functionally limiting burn scars. Scar revision surgery improves scar appearance and function by excising existing tissue and rejoining skin edges with a finer closure. It can make a scar less noticeable and may be combined with other techniques.
Skin grafting involves transplanting healthy skin from a donor site to cover the scarred area. Split-thickness grafts, including epidermis and part of the dermis, are used for larger areas. Full-thickness grafts, comprising all skin layers, offer better cosmetic outcomes, preferred for smaller, visible areas like the face. These grafts can release contractures and provide new, healthier skin.
Flap surgery is a complex procedure where skin, sometimes with underlying fat or muscle and its own blood supply, is moved from a nearby area to reconstruct the scarred region. It is often used for deep or extensive scars, particularly over joints, where robust, well-vascularized tissue is needed to restore function and contour.
Z-plasty is a surgical technique used to lengthen a contracture scar and change its direction, improving flexibility and reducing the visible straight line of the scar. This technique involves making Z-shaped incisions to rearrange tissue, which helps release tension and improve range of motion.
Ongoing Management and Outlook
Managing burn scars is an ongoing process requiring sustained care to optimize outcomes. Daily moisturizing maintains scar pliability, reduces dryness, minimizes discomfort, and improves appearance over time. Physical therapy prevents and treats contracture scars, using exercises and stretching to maintain or improve joint mobility and tissue flexibility.
Regular physical therapy counteracts the natural tendency of scar tissue to tighten and restrict movement, especially when scars cross joints. Support groups or counseling provide psychological support, helping individuals cope with the emotional impact of visible scarring and adjust to changes in body image. This holistic approach addresses both physical and emotional well-being.
Scar maturation can take 12 to 18 months or longer, during which the scar continues to soften, flatten, and fade. While complete elimination is not possible, significant improvements in appearance, flexibility, and comfort can be achieved with consistent care and appropriate interventions. Consulting healthcare professionals, such as dermatologists or plastic surgeons, is important for personalized treatment plans and managing expectations.