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Burn survivors can become frustrated that they still have issues with scarring after their initial burn injury has healed. Hypertrophic burn scars (raised scars in the area of the original burn) are the most common complication of a burn injury and can limit a survivor’s ability to function as well as affect their body image. It is difficult to predict who will develop scarring. Research shows that less severe burns that heal in less than 14 days generally have no scarring. More severe burns heal in 14 to 21 days and put you at a risk of scarring. Burns that take more than 21 days to heal are at very high risk for scarring and may require skin grafting.
Scarring is related to age, ethnicity, and the depth and location of the burn. 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 collagen fibers are laid down in a very organized manner, but in hypertrophic scars these fibers are created in a very disorganized manner, which gives the new skin/scar a different texture and appearance. Scar healing can take a long time. Scarring usually develops within the first few months after the burn, peaks around 6 months and will resolve or “mature” in 12-18 months. As scars mature they fade in color, become flatter, softer and generally less sensitive.
Hypertrophic scars:
Contractures 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:
Burns can damage or destroy the oil glands that normally keep skin from getting too dry. Partial thickness burns have few oil glands and full thickness burns or skin grafts have no oil glands. The lack of oil glands leads to dry skin. The chaotic organization of collagen in the healed skin may trap nerve endings, which also contributes to itching.
Many patients experience intense itching after their burn. Studies have shown that the larger the burn, the more likely that itching will be a problem.
Ask your doctor for recommendations on what moisturizer is best for you. Moisturizers with high water content, such as those that come in a bottle generally soak into the skin faster and will need to be applied more frequently. Moisturizers that come in a tube or jar are generally thicker and have less water, so they need to be applied less frequently. Be sure to avoid products that you may be allergic to, such as perfumed lotions.
The approaches for itching are varied. Keep skin moist is the starting point. Also massage or pressing down firmly on the scars may help. Scratching increases inflammation and will make itching worse. Elastinet garments or custom pressure garments may also help with itching.
Medications such as gabapentin or pregabalin (which are commonly used for nerve pain) have been shown to be the first line medication for itching. Antihistamines may also be helpful. Talk to your doctor about what medication is right for you. You should never use mineral oil, Vaseline 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.
You should avoid exposing your healing scars to sunlight. Scars that are discolored and have not matured burn easily. If you go out in the sun, we recommend:
You will need to work closely with your doctor and therapy team to make sure your scars heal 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 scars. For many years, custom pressure garments were thought to be the best treatment for hypertrophic scars. Custom fit pressure garments may be useful for decreasing postburn itch and scar formation.
The healing process can often seem long and frustrating for a burn survivor and his or her family. If you have concerns or questions about your healing process or treatments, contact your health care providers.
Additional resources for garments and scar products: 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.
Anzarus, A., Olson, J., Singy, P., Rose, B., Tredget, E. (2009). The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62.77-84.
Durani, P., McGrouther, D.A., Ferguson, M.W.J. (2009) Current scales for assessing human scarring: A review. Journal of Plastic, Reconstructive & Aesthetic Surgery, 62.713-720.
Edwards, Jacky. (2005) The use of silicone gel in hypertrophic scar management. Journal of Community Nursing, 19.12.18-20.
Esselman, Peter C. (2007) Burn Rehabilitation: An Overview. Archives of Physical Medicine and Rehabilitation, 88.2. S3-S6
Gabriel, Vincent. (2011). Hypertrophic Scar. Physical Medicine and Rehabilitation Clinics of North America, 22,301-310.
Urioste, S., Arndt, K., Dover, J. (1999). Keloids and Hypertrophic Scars: Review and Treatment Strategies. Seminars in Cutaneous Medicine and Surgery, 18.2.159- 171.
Williams, F., Knapp,D., Wallen, M. (1998). Comparison of the characteristics and features of pressure garments used in the management of burn scars. Burns, 329-335.
Wound Care and Scar Management after Burn Injury was developed by Sandra Hall, PT, Karen Kowalske, MD, and Radha Holavanahalli, PhD, in collaboration with the University of Washington Model Systems Knowledge Translation Center.
Scar Management After Burn Injury was reviewed and updated by Sandra Hall, PT; Karen Kowalske, MD; and Radha Holavanahalli, PhD. The review and update is supported by the American Institutes for Research Model Systems Knowledge Translation Center. The review and update was supported by the American Institutes for Research Model Systems Knowledge Translation Center.
Source: Our health information content is based on research evidence and/or professional consensus and has been reviewed and approved by an edito¬rial team of experts from the Burn Injury Model Systems.
Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding speci?c medical concerns or treatment. This publication was produced by the Burn Model Systems in collaboration with the University of Washington Model Systems Knowledge Translation Center with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, grant no. H133A060070. It was updated under the American Institutes for Research Model Systems Knowledge Translation Center, with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DP0082). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this fact sheet do not necessarily represent the policy of the U.S. Department of Education or the U.S. Department of Health and Human Services, and you should not assume endorsement by the federal government.
Copyright © 2016 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.