Burn scars result from full-thickness injury to the skin, reaching down to the deeper dermis layer. When this happens, the skin loses its elasticity and ability to regenerate the normal epidermal structure. Collagen production is disrupted, leading to the formation of scar tissue. While minor burn scars have the potential to heal and fade over time, severe burn scars are generally permanent. However, there are treatments available to improve the appearance and texture of scars.
Quick Answers
Can burn scars completely disappear?
In most cases, no. If the burn injury reached the dermis, it is very unlikely for the scar to completely disappear and go back to normal skin. However, proper treatment can significantly improve the appearance of scars over time.
Do burn scars fade?
Yes, minor burn scars will often fade gradually on their own over 1-2 years. Deeper scars take longer to fade but can be helped along with scar treatment methods.
Can laser treatment remove burn scars?
Laser resurfacing is an effective treatment for reducing the appearance of burn scars, improving skin texture, elasticity and pigmentation. While it does not completely remove or erase scars, it can make them look and feel smoother.
Do mederma and silicone sheets help burn scars?
Yes, products like Mederma and silicone sheets are evidence-based treatments that can help improve scar texture, color, and pliability when used consistently over time. They may lead to modest improvement but work best when combined with other treatments.
How Burn Scars Form
Burn injuries that damage the deeper dermis layer of the skin trigger an inflammatory and wound healing response that disrupts normal collagen production. Collagen is the protein that gives skin its structure and elasticity.
When burn injuries destroy collagen cells and blood vessels, the body produces excessive amounts of collagen haphazardly to quickly heal the wound. This leads to the formation of thick, raised hypertrophic scars with inflexible fibrous tissue.
The depth of the original skin injury determines the extent of collagen damage and scar formation. Superficial first-degree burns involving only the epidermis generally heal without scarring. But deeper second and third-degree burns that extend into the dermis undergo extensive scarring during healing.
Key Points on How Burn Scars Form:
- Burns injure different layers of the skin, from epidermis to dermis.
- Deep dermal burns destroy collagen and blood vessels.
- The body produces excessive collagen rapidly and haphazardly.
- This disorganized collagen forms inflexible, raised scar tissue.
The degree of scarring also depends on the overall surface area and location affected. Larger surface burns lead to more widespread scarring and contractures. Areas like the neck, shoulders and joints are more prone to mobility problems from scarring.
Stages of Burn Scar Maturation
Burn scars tend to evolve through several stages over time:
1. Inflammatory Phase
– Immediately after the initial burn, inflammatory cells like leukocytes and macrophages are recruited to the site of injury. This acute inflammatory phase lasts around 2 weeks.
2. Proliferative Phase
– In this phase lasting 2 weeks to 3 months, fibroblasts proliferate to quickly repair injured tissue by producing disorganized scar collagen. New blood vessels also develop.
3. Maturation Phase
– Occurring between 3 months and 2 years post-burn, this phase involves gradual collagen remodeling to achieve maximum tensile strength. However, the scar collagen remains abnormal compared to uninjured skin.
4. Long-term Remodeling
– Collagen remodeling and maturation continues at a slower rate for 2+ years. Some natural improvement in scar texture and appearance may occur with time.
So while burn scars tend to stabilize and mature around 2 years post-injury, they are subject to gradual long-term changes. But without intervention, significant deviations from normal skin texture and architecture remain.
Can Burn Scars Ever Return to Normal?
Unfortunately, the simple answer is no. The altered structural integrity of full-thickness burn scars means the skin can never be restored to its original undamaged state.
However, “normal” is relative when it comes to scars. With a combination of treatments and time, burn scars can be softened, flattened, faded and made much less noticeable. While they may not return to pre-burn condition, full restoration of function and acceptable cosmesis is possible.
Here’s an overview of what to expect with burn scars:
- Superficial partial-thickness burns can heal with minimal scarring.
- Deep partial and full-thickness dermal burns lead to permanent scarring.
- Severe scars may restrict mobility if located over joints.
- Treatment can improve scar thickness, coloration, and texture.
- Complete eradication of scarring is not possible if the dermis is damaged.
So while scars cannot be erased, the right treatments can camouflage and minimize their appearance.
Scar Reduction Treatments and Techniques
A variety of clinical and at-home treatments can help reduce and resurface burn scars over time. Here are some of the most effective options:
Laser Skin Resurfacing
– Laser therapy uses targeted beams of light to remove outer layers of scarred skin. This stimulates new collagen growth and skin remodeling. It smooths texture, reduces thickness, and fades discoloration. Takes multiple sessions but offers significant improvement.
Dermabrasion
– Uses a rapidly rotating instrument to abrade the scar surface. This removes damaged tissue to allow new growth and collagen realignment. Helps flatten and smooth scars. Several sessions are needed for best results.
Surgical Excision and Skin Grafting
– In some cases, surgical cutting out of the scar may be done, followed by skin graft placement. Improves function in addition to appearance in locations like joints.
Cryotherapy
– Liquid nitrogen is applied to the scar to destroy abnormal fibrous tissue. This allows healthier collagen to form when the skin regenerates. Minimizes scar thickness and rigidity. Multiple treatments required.
Silicone Gel Sheeting
– Self-drying silicone sheets are worn over scars to increase hydration and elasticity in the area. Also reduces inflammation to encourage healing. Especially effective for hypertrophic and keloid scarring.
Compression Therapy
– Pressurized garments are worn to help flatten and soften scars. Helps realign collagen fibers. Needs to be used for 12+ hours per day to be effective.
Intralesional Steroid Injections
– Steroids like triamcinolone are injected directly into thick, raised scars to inhibit inflammation and abnormal collagen deposition. Helps reduce hypertrophic scarring.
Radiotherapy
– For severe scarring, targeted radiation can be used to control excessive fibroblast proliferation. Helps tone down overgrown scars.
Topical Creams and Oils
– Products like Mederma, vitamin E oil, and onion extract cream can improve scar texture, color, and size when applied daily. Modest but incremental results.
Skin Needling
– Devices with fine needles are rolled over scars to puncture the skin and stimulate collagen remodeling. Encourages realignment of disorganized scar tissue.
A personalized combination of such treatments, tailored to the individual and their scarring, offers the best results over time.
Home Scar Management Techniques
Along with clinical treatments, proper at-home care can optimize burn scar healing and appearance. Key tips include:
- Massaging scars daily with lotion to improve pliability.
- Silicone gel sheeting for 12-24 hours per day.
- Using sun protection on scars to prevent darkening.
- Performing stretch exercises to improve range of motion.
- Drinking plenty of water and eating vitamin-rich foods to support healing.
- Avoiding injury or irritation to the scar area.
Consistency is vital when caring for burn scars at home. Following skin care best practices and provider instructions can maintain results from clinical scar reduction treatments.
Does Scar Severity Matter for Healing Potential?
Yes, the more severe and deeper the original burn injury, the worse the resulting scar damage. Different degrees of burns correlate with progressively decreasing chances for the skin to heal and regenerate normally:
First-Degree Burns
– Superficial burns involving only the outer epidermis layer can heal without any scarring. Proper care helps the skin regenerate and return to its pre-burn state.
Second-Degree Burns
– Partial-thickness burns extending into the upper dermis cause minimal to moderate scarring. Scars improve gradually and can approach near-normal appearance with treatment.
Third-Degree Burns
– Full-thickness injury reaching deep dermis and underlying fat result in heavy, inflexible scarring. While treatment can enhance texture and appearance, these scars remain permanently noticeable.
Fourth-Degree Burns
– The most severe burns involving muscle, tendon, and bone lead to devastating scarring with physical limitations. Even after extensive treatment, these scars remain disfigured and dysfunctional.
So the deeper and more extensive the original skin damage, the less potential exists for the skin to heal without permanent significant scarring. Early optimal care can improve long-term scar results.
Does the Body Absorb Hypertrophic Scars Over Time?
Hypertrophic scars form when excessive amounts of disorganized collagen build up rapidly during the skin’s post-burn healing process. The body does work gradually to remodel this haphazard scar tissue, but it does not completely absorb hypertrophic scars. Here is the process:
- The inflammatory phase deposits excessive collagen into wounds.
- Proliferative healing lays down fibrous proteins quickly without structure.
- In maturation, cells called myofibroblasts reorganize collagen fibers.
- Remodeling very gradually aligns fibers and reduces scar bulk.
- But the irregular foundation remains permanently as hypertrophic tissue.
Without intervention, the body can only optimize and organize the collagen that is present. The basic scar components are not dissolved or absorbed away. The effects of treatments like steroids, silicone, and laser therapy help stimulate controlled remodeling. But the body cannot automatically smooth away these proliferative scars over time. Their foundational structure persists unless more actively treated and revised.
What Factors Influence the Healing of Burn Scars?
How well a burn scar ultimately heals depends on several key factors:
Burn Severity
– Deep second and third-degree burns have worse scarring potential than superficial burns.
Skin Pigmentation
– Paler skin is more susceptible to noticeable dyspigmentation than darker skin.
Age
– Younger skin has a better ability to regenerate and heal with less scarring.
Genetics
– An individual’s genetic tendency for scarring affects outcomes.
Size of Burn
– More extensive burns have increased risk of hypertrophic scars.
Location
– Joints, neck, and hands are prone to more functional impairment from scarring.
Aftercare
– Proper wound care and scar management improve healing potential.
Secondary Infections
– Infections in the healing wound worsen scarring.
Optimizing these variables with early expert care gives the best chance for burn scars to heal with positive long-term outcomes. While a return to pre-burn normalcy is impossible for full-thickness burns, diligent treatment can promote significant improvement over time.
Conclusion
Full-thickness burn injuries that reach the deeper dermal skin layer will result in permanent scarring to some degree. While this scarring cannot be erased completely, the right treatments can dramatically improve texture, appearance, and function. Burn scars do not disappear or get absorbed entirely over time. However, a combination of clinical therapies, at-home care, and gradual collagen remodeling can reduce scars significantly. Although complete normalization is not possible, with consistent effort, burn scars can often be restored to a satisfactory state.