Scar Management after Burn Injury

Scars occur after burn injury. Some scars may impact a burn survivor both physically and mentally after their initial burn injury has healed. It is difficult to predict who will develop scarring, though scarring is related to skin tone and texture prior to burn injury, as well as the depth and location of the burn.

Why Do Scars Form?

Scars form when the dermal or lower layer of the skin has been damaged. The body forms a protein called collagen to help heal the damaged skin. Normally the skin collagen fibers are laid down in a very organized manner, but in scars, these fibers are created in a very disorganized manner, which can give the new skin/scar a different texture and appearance.

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How Long Does it Take Scars to Mature?

Scars will “mature” or change over time and can limit a survivor’s ability to function, as well as affect their body image. Scarring usually develops within the first few months after the burn, peaks around 6 months, and may improve or mature in 12-18 months.

Research shows that less severe burns that heal in less than 14 days generally have no scarring. Burns that take longer to heal are at higher risk for problematic scarring and may require further treatment, including reconstructive surgery. The scar maturation process can often seem long and frustrating for a burn survivor and their family. Physically, one might notice their scars:

• Can be dry, leading to cracking or breakdowns of the skin.
• Are more sensitive to touch and their physical environment, for example, exposure to the sun and certain bath or body products.
• Can lead to symptoms such as neuropathic pain or nerve pain, as well as a pins and needle sensation in the scar.

As scars mature, they fade in color and become flatter, softer, and generally less sensitive. People with visible scars may feel self-conscious and avoid social situations. This can lead to isolation, depression, and lower quality of life. If you have concerns or questions about your healing process, treatments, or mental and physical health, contact your health care providers.

Caring for Your Scars

Moisturize

It is important to keep your scars clean and well moisturized for the best outcome. Massage your scars with lotion to keep them moist, make them less sensitive, decrease itching, and make stretching easier. This may also prevent skin breakdown.

• Moisturizers can be applied to all healed areas frequently throughout the day.
• Moisturizers should be applied in thin layers and massaged in gently while the scars are more fragile. As your scars mature, you can begin to add more pressure to help your scars loosen so that they are not so stiff.
• Hot showers remove the natural oils from the skin. Therefore, it is essential to re-moisturize well after showers. Bathing may feel good but also removes the natural oils. Adding baby oil to the water may alleviate some of this effect.

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When picking a moisturizer, be sure to avoid products with fragrances or alcohol. You should never use mineral oil, petroleum jelly, or antibiotic ointments to moisturize your skin. These can lead to allergic reactions and skin breakdown. Do not use antibiotic ointment to lubricate after the wound is healed. Check out the below resources for more tips on picking a moisturizer and itchy skin after burn injury. You should also talk to your doctor about what treatments or medications might be right for you.

• Factsheet: Itchy Skin after Burn Injury (https://bit.ly/Itchy-Skin-Factsheet)
• Infographic: How to Select a Moisturizer for Itchy Skin After Burn Injury (https://bit.ly/Moisturizer-Infographic)

Sun Exposure

You should avoid exposing your scars to sunlight. Scars that are discolored and have not matured burn easily. If you go out in the sun, we recommend

• Planning activities in the early morning or late evening when the sun is the least intense.
• Applying a broad-spectrum sunscreen with an SPF level greater than 30 frequently to maintain protection.
• Re-applying sunscreen every 2 hours.
• For more information, check out our factsheet: Sun Protection After a Burn Injury (https://bit.ly/ Sun-Protection-Factsheet)

Contractures

Scars across joints can lead to contractures and can affect your ability to move and take care of yourself. If your contractures involve your legs, you may have difficulty squatting, sitting, walking, or climbing stairs. If your contractures involve your trunk and arms, you may have difficulty with grooming, eating, dressing, and bathing as well as working with your hands. Some contractures are unavoidable, but many can be prevented with active involvement in your rehabilitation program. Here are a few reminders:

• Stretching should be performed a minimum of five to six times per day. To make stretching easier, first moisturize your scars with a moisturizer recommended by your doctor.
• Your therapist may make a cast or splint to help position your scar in a stretched position. It is important that you wear the cast or splint as prescribed and tell your therapist if it becomes painful or causes skin irritation.
• Do as much for yourself as possible such as getting dressed and self-grooming. It may take longer than you are used to, but movement and activity will improve your ability to move and take care of yourself.

What Are Hypertrophic Burn Scars?

Hypertrophic burn scars are raised scars in the area of the original burn and are the most common complication of a burn injury. Hypertrophic scars generally develop from more severe burn injuries and:

• Stay within the area of the original burn injury.
• Develop within the first few months after injury.
• Often have a deep red to purple color and are raised above the surface of the skin.
• Can be warm to the touch, very sensitive, and itchy.
• Are more prominent and noticeable around joints where skin tension and movement are high.

What Are Keloid Burn Scars?

Keloid burn scars are very similar to hypertrophic scars, with the major difference being keloid scars do not stay within the area of the original burn injury.

Treatment of Hypertrophic and Keloid Burn Scars

You will need to work closely with your doctor and therapy team to make sure your scars mature as completely as possible. A strong commitment is required from you and your family member to follow through with the treatment plan to ensure the best scar result. No single treatment is ideal for treating hypertrophic scars.

• You and your medical team may decide to use pressure garments. They can decrease itching and protect the skin from injury. Some burn survivors also feel that the pressure garments look better than the scars themselves.
• Gel sheets are pieces of thin, flexible material that are placed over the scars and may decrease itching and dryness. They are generally durable and comfortable to wear. They can be worn alone or underneath pressure garments, splints, or casts. Some people find that they are sensitive to silicone, so check your skin frequently for irritation or rashes.
• Your therapist may recommend custom-made inserts to be worn under gloves, compression bandages, or custom garments to increase pressure on the scar and improve maturation. These inserts can be made from a variety of substances, ranging from soft foam to a rubber consistency.
• Massage can help soften and desensitize the scar. When combined with stretching, massage can make the scar looser, softer, and more comfortable. Talk to your therapist to learn about specific massage techniques.
• Surgical treatment, including laser treatment, may be an option if scarring prevents you from performing certain activities. It is important to stay in contact with your treating burn physician for evaluation.

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For more information regarding compression garments, wound care, and scar management products, please contact your doctor or therapist so that they can make recommendations based on your specific needs.

What Can You Do?

• Be actively involved in your recovery by asking questions and participating in decision making about your care. Take a list of questions or concerns to your medical appointments for your health care provider to address.
• Keep up your exercise program as recommended by your doctor.
• It is important to follow your providers’ instructions for using pressure garments, inserts, splints, or gel sheets. If they do not fit properly or if they cause problems such as pressure or skin breakdown, let your health care provider know right away.

Authorship

Scar Management After Burn Injury was originally developed in 2016 by Sandra Hall, PT, Karen Kowalske, MD, and Radha Holavanahalli, PhD, in collaboration with the Model Systems Knowledge Translation Center (MSKTC). This factsheet was reviewed and updated in 2024 by Lauren J. Shepler, MPH, Huan Deng, PhD, Jonathan S. Friedstat, MD, and Jeffrey C. Schneider, MD, Boston-Harvard Burn Injury Model System in collaboration with the MSKTC.

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Burn Model System (BMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The content of the factsheet has also been reviewed by individuals with burn injury and/or their family members.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. The contents of this factsheet were originally developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR; grant number 90DP0012) and were updated under an NIDILRR grant (90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended citation: Shepler, L. J., Deng, H., Friedstat, J. S., & Schneider, J. C. Scar management after burn injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/burn/factsheets/scar-management-after-burn-injury

Copyright © 2024 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.

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