How Burn Scars Are Treated

After a burn has healed, you’ll likely be left with a scar—especially if you had a second or third-degree burn. The severity of scarring depends on the depth of the burn and how it was initially treated and managed. You can't usually completely eliminate burn scars, but you can treat them and reduce their appearance.

Treatments for burn scars generally fall under four main categories:

  • Over-the-counter topical treatments
  • Non-surgical specialist procedures
  • Laser therapy
  • Surgery

Treatment options depend on whether you want to improve the appearance or whether the scar has caused skin contractures (tight areas of skin) that affect your ability to move.

burn scar treatment

Verywell / Brianna Gilmartin

Over-the-Counter Topical Treatments

Moisturizers and Emollients

Constant itchiness is a common issue with burn scars. This happens because burns impair or destroy oil glands in the affected area, which leads to dry and itchy skin.

Using moisturizers and emollients can help. Make sure to use unscented/fragrance-free creams to avoid skin irritation.

You should place moisturizers carefully and gently when the burn scars are still new. With time, as the scars become less fragile, you can apply more pressure when placing the moisturizers to help prevent scar stiffness and loosen up the area.

Silicone Gel Sheets

These are thin pieces of medical-grade silicone that are worn on the skin to help with scarring. They have been used in the treatment of burn scars for more than 30 years and are accepted as one of the best non-surgical options for burn scars.

Silicone gel (whether in sheet form or not) has been proven to help reduce the thickness of burn scars. It also diminishes itchiness and pain at the site of the scar. Silicone gel sheets can be used on your scars even if the scars are causing stiffness and interfering with movement.

For maximum effectiveness, you should use silicone gel sheets on your skin for at least six to 12 months of constant wear.

When using this treatment, it is important that you keep your skin clean to avoid skin rashes, irritation, or infections, especially if you live in a hot or warm weather area. You shouldn't use silicone over any unhealed skin or in combination with antibiotic skin ointments.

Allergic reactions to silicone gel are rare. If you start to develop any skin reaction, you should stop applying it immediately and go see your healthcare provider.

Massage Therapy

Massage therapy is used to reduce the pain, skin sensitivity, and itchiness that usually come with burn scars. Additionally, it can reduce the height and appearance of your burn scars. And because it involves manipulating the scar tissue that’s under your skin, massage therapy lessens the tightness and restriction of movement. If you’re having trouble moving the affected areas freely and fluidly, properly administered massage therapy can help.

There are different kinds of massage techniques used in burn centers, including kneading, skin rolling, stretching, and stroking. Your healthcare provider or occupational therapist should instruct you on how and when to perform these techniques at home.

You shouldn’t massage skin that’s infected, fragile, or not fully healed.

Pressure Therapy

This method of treating burn scars has been in use for decades and it is usually the first treatment option for hypertrophic (raised scars) in burn centers.

The treatment uses pressure garments—elastic garments that are worn to apply pressure to the scar areas. If the burn scars are on your face, the pressure will be applied using transparent face masks. Pressure therapy should be used for 6 to 12 months in order for it to be effective, and it is advised that you wear the garments for 23 hours per day.

This photo contains content that some people may find graphic or disturbing.

hypertrophic burn scar
Hypertrophic burn scar.

DermNet / CC BY-NC-ND

While it’s a very effective method of treating (and even preventing) hypertrophic burn scars, there are a couple of problems associated with pressure therapy:

  • Wearing pressure garments can be very uncomfortable and can cause blistering, particularly if you live in a hot and humid climate.
  • The garments can cause overheating, itchiness, and wound breakdown.

Pressure therapy is to be implemented by your healthcare provider while you’re at the hospital, and you’ll continue with it at home as directed.

It’s important to note that despite its pervasiveness in hospitals and clinics, there isn't a lot of medical literature backing up the efficacy of pressure therapy.

Steroid Injections

Steroid injections are mainly used to treat keloid scars (raised, smooth, thick, and rounded scars that sometimes go outside the boundaries of the original burn injury). Steroids, such as corticosteroids, are injected into the scars to soften and shrink them. The injected steroids can also help reduce the pain and itching that’s generally associated with burn scars. 

If you receive this line of treatment, you may experience side effects, such as skin discoloration and skin thinning. Allergic reactions to steroid injections are very uncommon.

Steroid injections are done at the hospital or clinic and you shouldn't try to do them yourself at home.

Laser Therapy

Laser treatments are used to relieve tightness, discomfort, and pain from burn scars, as well as smooth them out and diminish their redness. There are different kinds of laser therapies used to treat burn scars. The main ones are pulse-dyed laser, fractional laser (ablative and non-ablative), CO2 laser, and Q-switched laser. If you’re considering whether or not to have laser treatments, consult with your healthcare provider.

Before and after having laser therapy, you should be diligent about sun protection. Following your surgeon’s or dermatologist’s post-laser instructions in taking care of the site is also a must.

With laser treatment, it’s possible that you may need more than one treatment and it may also take several weeks before you start to see results.

Common side effects of laser treatments include redness, swelling, hyperpigmentation (dark skin discoloration), itching, and the formation of new scars. The consensus drawn from many studies and clinical trials is that using laser therapy to treat burn scars is safe enough that the benefits outweigh the potential risks.

Surgical Treatments

Surgery can be an option for treating scarring when large areas of skin have been severely damaged, causing contractures to form, with tight skin and limited movement.

Most surgeries performed on burn scars are done to improve range of motion, and this may sometimes necessitate the removal of scar tissue that has formed underneath the skin. The types of surgeries used to treat burn scars include the following.

Skin Graft

During this procedure, a thin piece of skin is taken from an unaffected part of the body (usually the buttocks or inner thigh) and used to replace the scarred skin. After the surgery, your skin should be more flexible, but you may have scarring with skin texture irregularities or discoloration.

Skin Flap

This procedure is very similar to a skin graft, with the major difference being that the skin taken from the healthy body part has its own blood supply. This means blood vessels, fat, and muscles are taken along with the piece of skin. This procedure is usually used when the blood supply to the scarred skin is damaged.

Z Plasty

This surgical procedure involves making a Z-shaped incision into your burn scars. It reduces the number of contractures, thereby improving flexibility and decreasing tightness. It also minimizes the appearance of the scars and can be used to reposition your scars in order to make them less noticeable and blend in better with natural creases in the surrounding skin areas.

Tissue Expansion

This procedure is a new technique that is often used in addition to flap surgery when the burn scars are to be removed either partially or in their entirety.

A balloon-like object called a tissue expander is placed under an uninvolved part of your skin near the scarred area. This tissue expander will be continuously filled with saline solution, and over time the normal skin it was placed under will stretch out.

Once the surgeon deems the skin to be adequately stretched, the scar is removed, and the stretched skin is pulled over and used to cover the opening.

Dermabrasion

This involves surgically sanding and scraping the top layer of your burn scars in order to make them smoother and improve their appearance.

Fat Graft

This surgical procedure can be used if your burn scars are uneven and depressed in some places. It involves transplanting fat from a healthy part of your body to the scarred and depressed areas to raise them and make their appearance smoother.

What to Expect Post-Surgery

While results and effects vary, there are a couple of things you should expect after undergoing surgery for your burn scars:

  • You should expect your healthcare provider or surgeon to give you detailed instructions for taking care of the site when you get home. To avoid post-surgery complications, it’s crucial that you adhere to these instructions.
  • You should know that some of these surgical procedures can involve pain, especially in the aftermath after the anesthetic you may have been given has worn off. Swelling and redness around the scar area are also common.
  • The different surgeries come with their own unique risks and side effects, all of which you should discuss with your surgeon or healthcare provider prior to undergoing them.

Your healthcare provider may have you wait months or even years before a burn scar surgery so your body to heal fully and properly. This depends on the size and location of your burn, and how well it is healing.

A Word From Verywell

With burn scar treatments it’s imperative that you discuss your options with your healthcare provider or surgeon before undergoing any of them. Some of these treatments can be used in combination with each other, or in sequence.

It’s also important for you to have realistic expectations, as it is highly unlikely that your burn scars will go away completely (except when they are really minor). Surviving serious burns and being left with scars can be devastating and can affect your confidence. If you are struggling to accept the changes in your appearance, consider visiting a psychologist or therapist who can help you with emotional and psychological healing.

Frequently Asked Questions

  • Do first-degree burns leave a scar?

    First-degree burns can leave a scar, especially without proper treatment. To treat a first-degree burn and prevent scarring, remember these steps:

    • Cool the burn using cool (not cold) water for around 10 minutes or until pain goes away.
    • Apply petroleum jelly to the burn two or three times each day.
    • Keep the burn area covered with a clean, non-stick bandage.
    • If needed, take an over-the-counter pain medication for pain relief and to reduce inflammation.
    • Keep the burn away from direct sunlight. Stay in the shade, wear protective clothing, and apply water-resistant sunscreen that is SPF 30 or higher.
  • What are contracture scars?

    Contracture scars are any type of scar that limits movement. After a burn, this can happen when healed tissues form a scar that is tighter and thicker than normal skin. For example, a contracture scar on the arm can make wrist, forearm, and finger movement more difficult. Many second and third-degree burns can cause contracture scars, and this is one of the reasons why proper burn treatment is important.

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11 Sources
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