Managing burn scars

Scars are natural parts of the healing process. They’re a sign that the burn wound is healed. But burn scars look different from normal skin and can be itchy and tender to the touch. In some severe cases, burn scars can even make it hard for you to move.

Our team of specialists uses several scar management and scar rehabilitation treatments to prevent burn scars and lessen their appearance. With treatments ranging from compression therapy to scar massage, we’ll guide you to the treatment that might work best for you.

When a wound is so deep or wide that its edges can’t touch as it heals, a visible scar may form. Scar tissue is made of collagen, the tough material made by the fibroblasts (the fiber-making cells that rebuild all injuries).

In smaller cuts we can’t see the small amount of collagen fiber that forms beneath the surface of skin. But in a larger wound, so much fiber is needed to fill the gap that it’s visible. This visible tissue is what we call a scar.

Because scar tissue is made of fibers, not skin cells, it’s stronger than ordinary skin. Unlike skin, scar tissue doesn’t have hair, sweat glands or blood vessels. It may look shiny and it’s often a different color from the skin around it.

When someone is burned, they’re often left with a scar after the skin is done healing. Depending on how bad the burn was, burn scars may not be noticeable or very noticeable.

If someone has a skin graft, the site where the donor skin came from can also scar. A donor site that isn’t done healing (immature donor site) may be painful and itchy. An immature donor site may also have scars that are red. Occasionally, donor sites become raised.

The color of a mature donor site or skin graft will more closely match the surrounding skin, doesn’t itch and is no longer painful. Mature skin is softer and moves more easily. However, mature donor skin doesn’t look exactly like unburned skin, and it never will. But with the proper treatment, burned skin can heal with the least amount of scarring possible.

There are three main types of burn scars: hypertrophic, keloid and contracture.

A hypertrophic scar is a thick, raised scar. They can look pink, red or purple, but may look different depending on your skin tone. Hypertrophic scars are harmless but can be itchy or uncomfortable. If the scars bother you, treatments can be used to help flatten them.

Keloid scars occur when there’s an overgrowth of scar tissue. They’re hard, raised and rubbery. Keloid scars often look shiny compared to the surrounding skin. Most often, they fade to a more normal skin tone over time. Keloid scars are usually painless but can be itchy or tender to the touch.

This type of scar more commonly develops on the head, shoulders and upper chest but can appear anywhere.

A contracture is when skin is pulled together from the edges of a burn to cover the wound. When this happens, the scar creates a tight area of skin. Skin tightness can make it more difficult for you to move, especially if the scar forms over a joint. In some cases, surgery is needed to release the scar and improve your mobility.

We use several different burn scar treatments, including scar massage, pressure therapy, laser therapy and surgery. Our burn experts will guide you toward the treatment that works best for you.

Massaging the burn scar is a technique we use to soften the scar tissue. It can help release any adhesions (bands of scar tissue that connect two body parts that are usually separate) in the scars. It’s safe to massage burn scarring when the wound is durable enough to handle the pressure and friction without blistering.

Initially, the massage is done with light pressure, moving the skin without friction. As the skin becomes more durable, you can increase the pressure and start frictional massage.

Pressure therapy for scar management, also known as compression therapy, is an important part of your healing process. Compression therapy keeps the severity of burn scars to a minimum. It does this by interfering with the skin’s ability to produce scar tissue (collagen fibers). Plus, it helps realign the collagen fibers.

During pressure therapy, elastic bandages (compression garments) are used to put pressure over healing burns and grafts. We start using compression garments when the healing skin is durable enough to tolerate fabric against the skin.

Benefits associated with compression therapy include its ability to:

• Protect fragile skin
• Promote better circulation in damaged tissues
• Decrease extremity pain through vascular support
• Decrease itching
• Reduce thick, hard scars
• Increase skin length by putting pressure on contracture bands

We use many different types of compression garments to treat burns, depending on your specific needs.

• Elastic wrap bandages (Ace Wrap): These are often used early in your treatment to provide pressure on arms and legs.
• Tubular pressure bandages (Tubigrip): These are used early in your treatment to put gentle pressure on the burn wound.
• Interim care garments: We use these until custom-made burn garments are ready to be used.
• Custom-made garments: We use nylon spandex garments made to your measurements to apply pressure on your wounds. These garments are made by one of the manufacturers that specialize in burn compression garments.

In most cases, compression garments should be worn 7 days a week for 23 hours per day. You can take them off when you’re bathing or applying lotion.

For best results, compression garments need to be worn until the scars are mature. You know your scars are mature when they’re soft, flat, pliable and when the color is close to matching your skin tone. It takes between 8 months and 2 years before scars are mature. The length of time it takes to heal depends on the depth of the burn, your genetics and other factors.

Hand wash compression garments using mild soap or detergent. Don’t use bleach, it can damage the material. If you use a washing machine, running gentle or hand wash cycle is best. And don’t put your compression garments in a dryer, hang them up or lay them flat to dry.

Do your best to keep lotions or creams off of your compression garments. Rub moisturizing lotion or cream completely into the skin before putting on the garment to keep it clean.

It’s time to replace compression garments when they become loose and worn. Typically, three sets of garments last about three months.

If a burn scar is on a part of the body that curves inward (concave) or if the compression garment isn’t compressing the scar, we might add inserts or silicone gel sheets.

Inserts can be made of felt, foam, elastomer (a silicone rubber compound) or other materials. These inserts are worn under compression garments to place additional compression on burn scars.

Silicone products come in a variety of forms: in flexible sheets, creams or liquids, or on a Band-Aid. The gel sheets are reusable and should be washed each day. They can be worn alone or under a compression garment.

Lasers can be used to break down scar tissue and soften the skin. This type of treatment can improve your mobility and function. We might recommend laser therapy for any type of scar, but it’s most often used to treat hypertrophic scars.

In some cases, reconstructive surgery is needed to help manage the appearance of scars. Reconstructive surgery is performed after your wounds have healed. If you need surgery to treat your burn scars, we’ll connect you with our experienced plastic surgeons who specialize in burn survivors.

The best way to prevent burn scars is through proper burn treatment. If you’ve experienced a burn, we recommend reaching out to the Regions Hospital Burn Center. Our expert team of burn specialists will give you the immediate treatment you need, including scar prevention treatments.

If you have stubborn burn scars that you need help managing, our burn specialists can help. We help burn survivors rehabilitate from their injuries, including reconstructive surgery for scar management.