Scarring due to burns spans a whole spectrum. These scars can range from light or dark patches on the burn area to more significant and cosmetically and functionally debilitating hypertrophic and keloidal scars.
How to reduce a burn scar is a topic every person with a burn injury should familiarize himself with.
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This photo contains sesitive content which some people may find offensive or disturbing
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This photo contains sesitive content which some people may find offensive or disturbing
What kind of scar develops depends not just on the depth of the burn but also on the care received.
How to minimize a burn scar depends on the patient’s risk of developing a scar and their level of concern about the scar’s appearance.
The methods listed here to reduce a burn scar are a general guidelines and must be tailored to the specific needs of the situation, warranting the help of a professional trained in the management of burns to make the clinical judgment. With adequate guidance, scar reduction methods can be carried out at home.
Always get in touch with a qualified professional in case of a burn injury. This post is only a general guide to get you started before you meet your practitioner.
Quick Navigation
- No.1- Appropriate First Aid.
- No.2- The right burn care provider.
- No.3- Moisturize.
- No.4- Sun protection.
- No.5- Massage.
- No.6- Pressure garments.
- No.7- Silicone gel or sheet therapy.
- No.8- Exercises, stretches, and splinting.
- No.9- Have patience and persistence.
- No.10- Last but not least, eat well!
- Takeaway
No.1- Appropriate First Aid.
In a previous blog post, I discussed the appropriate immediate home care in acute burns: Burns First Aid At Home.
To sum up:
- Move away / extinguish the source of heat.
- Never use ice/ice cold water on the burn wound as it can increase the burn depth.
- Remove any jewelry or tight clothing.
- Use only ointments that are manufactured for burn wounds, and never use things like butter, toothpaste, ink, etc.
- Use correct dressing techniques.
No.2- The right burn care provider.
Visit a plastic or a burn surgeon with experience treating burns and their sequela.
The best thing you can do for your burn scar is consult with a burns specialist from the beginning.
Burns encompass a broad spectrum that can be as superficial as a sunburn to deep enough to char the whole skin.
Judging the depth of a burn accurately is a skill honed with experience. This is critical as the prognosis and the sequelae like burn scars depend on the burn depth and the treatment that was received at the time of the acute burn.
Administration of the proper treatment is essential to mitigate any adverse sequelae of the burn.
Here are some helpful resources for burns:
National Academy of Burns, India.
American Burn Association.
No.3- Moisturize.
Scars show poor barrier function and have increased trans-epidermal water loss.
Furthermore, depending on the burn depth, the glands that secrete oils take weeks to months to regenerate and lubricate your skin
Till that happens, the scar will feel dry and itchy and can lead to wounds due to constant scratching or friction with your clothes. This will impair the healing process and lead to scarring.
There is no set number of times that your should moisturize. Do it as frequently as you need to so the scar doesn’t feel dry and itchy. Aim for at least 3 to 4 times a day.
How to choose the right moisturizer?
Anything with minimal ingredients and without chemicals that add no value to the therapeutic benefit, like dyes/color and fragrance, should be preferred.
Added colors and fragrances are my two pet peeves that can result in allergic reactions on an already tender, burned skin.
My most recommended emollient for this purpose?
Good old basic coconut oil with no additives.
It is not only very effective as a moisturizer, but it is also cheap and readily available.
Also, it pairs well with massage therapy which is often done for the management of burn scars.
No.4- Sun protection.
Always use sunscreen and physical protection like a wide-brimmed hat or an umbrella when outdoors.
This is more important in fresh scars that are fragile than the surrounding normal skin. This fragile skin reacts differently to sun exposure by becoming darker.
Over time as the sun exposure continues, the pigmentation deepens and visibly stands out from the surrounding normal skin.
Treatment of this hyperpigmentation is often challenging, long-drawn, and expensive.
Use a broad-spectrum sunscreen with an SPF of at least 30 and one that has minimal ingredients. Avoid those with artificial dyes and added fragrances that can irritate the fragile skin.
Apply sunscreen 15 minutes before sun exposure and repeat every 2 hours or earlier if swimming or wiping off sweat.
You may often have to try multiple brands before you find one that suits the delicate burned scar.
No.5- Massage.
Massage of the scar tissue causes mechanical disruption of the scar tissue resulting in improved scar pliability and reduced pain and itching.
It can be done manually at home or in medical settings by a trained therapist using a vacuum device.
At-home massage therapy with the fingertips or heel of the hand is an economical, easy-to-learn, and an effective method of scar management.
You can use a moisturizer during the massage, not just for the ease of the gliding movement but also to avoid damage to the fragile burned skin, especially if it is a recent scar.
Do not be aggressive with the pressure.
The aim is to blanch the scar when your put pressure on it.
Do not massage a scar that is inflamed, has scabbing, or has an open wound. I recommend you take an initial class with a trained professional before massaging at home.
Aim for massage thrice a day for 15 minutes.
Massage will not help to heal certain scars like contractures (pictured above) but will increase the pliability of the scar, providing comfort and improving mobility.
For more information on scar massage at home, see this video:
No.6- Pressure garments.
Source: Mala Shukla, Blog Roll APSI.
Ideally customized for best results, pressure garments are often used in conjunction with silicon sheets and gels.
These come in the form of fitted garments that exert continuous pressure on the scar and help to reduce the height of the scar and any associated redness.
Pressure garments help to modulate the abnormal collagen fibers in the scar tissue and, due to their compressive effect, reduce blood flow to the scar inhibiting their growth.
As simple as it sounds, they can give rise to some complications like blisters and wounds and abnormal sensations like numbness or pins and needles.
These are typically worn at all times (except while bathing) and needs some time to get used to.
The pressure generated is very crucial and needs to be of the right degree for the garment to be effective and also needs regular monitoring to reduce the chances of complications.
Often the garment will need to be replaced every few weeks to months due to normal wear and tear. Due to this, it is important to get the garments fitted and supervised by a trained professional.
I would not recommend that you buy ‘one size fits all’ garments off the shelf.
No.7- Silicone gel or sheet therapy.
Source: Smith & Nephew.
Silicone can come in gel forms or as an occlusive adhesive sheet.
These are the gold standard, first-line options for both prevention and treatment of all types of scars, including burn scars.
While it is not known how exactly it works in scars, it is postulated that the occlusion provided by silicone helps in increased hydration of the skin.
The aim is to wear the silicone around the clock except while bathing or swimming. You can gradually increase the hours of usage by a factor of 4. E.g.,4 hours on the first day, 8 on the second, 12 on the third day, and so on.
Adverse skin reactions that can happen are itching, redness, blistering, skin breakdown, and allergies. These do not happen in every case and often can be avoided by progressively building up the duration of wearing it and maintaining appropriate hygiene.
The silicone gel will typically come with an easy-to-understand patient instruction booklet.
For those unable to tolerate occlusive silicone sheets, the use of silicon gels can be done.
In daily practice, silicone applications are worn with pressure garments or splints to achieve the best outcomes. Silicon sheets are pliable, making them easy to use in scars in contoured places, e.g., shoulder, and can also be cut to size as needed.
The drawback with these is they are expensive, need proper wash care, and have to be replaced every few weeks.
No.8- Exercises, stretches, and splinting.
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This is a crucial step in deep burn rehabilitation and is often overlooked. Burn rehabilitation starts from the first day of burns and lasts several years. While this will not make the burn scars disappear, it will help reduce the severity of scarring and help a person reach his maximum functional capability.
This requires the guidance of a trained professional who will individualize the therapy, and the exercises, stretches, and splint have to be continued at home with regular modifications as needed.
No.9- Have patience and persistence.
Burn scar healing is a protracted and slow process.
It depends on the depth and location of burns sustained, the healing process, which is variable from person to person, the age and ethnicity of the individual, etc.
Minor superficial burns heal in about 2 weeks with minimal to no scarring. As the burns get deeper, the healing process gets longer and more complicated.
In case of a deeper burn, scars usually develop within the first few weeks, reach their peak at 6 months, and take up to 2 years to settle to become ‘mature’ (softer, flatter, color improvement).
You are looking at a minimum of 2 years for your burn scar to improve, during which time you will be undergoing the concomitant therapy outlined above.
Deeper scars take even longer and may require multiple surgeries and rehabilitation procedures.
All the methods listed above require time, patience, and adherence to the therapy.
There is no quick fix to burn scar management, especially if it is a deeper burn.
No.10- Last but not least, eat well!
It is a given that good nutrition is essential for good health. It becomes more critical when you want wounds and scars to heal faster and better.
Proteins, vitamins A, C, & E, and zinc are essential for wound healing. A wholesome meal will provide you with all the essential nutrients. If you feel your needs are not met with diet alone, ask your doctor if you should start nutritional supplements- Do You Need Nutritional Supplements Routinely?
Quit smoking as it reduces blood (and thus, oxygen) flow to your tissues.
Stop binging on junk food that lacks essential vitamins and minerals.
Stay hydrated- How Much Water Should I Drink In A Day?
If you are diabetic, control your blood sugar as elevated sugar levels interfere with the healing process.
Takeaway
- Burns healing can take anywhere from 2 weeks to a couple of years, depending on the depth of injury.
- The healing of a burn injury depends on multiple factors, and it is essential and prudent to seek the advice of a trained medical professional.
- How to reduce a burn scar should be guided by a trained professional as once correct guidance is received many of the therapies like massage, exercises, etc, can be done by the patient and the caregiver at home.
- Do not forget sun protection and moisturization! They are often the only thing needed in case of minor burns.
