During the healing process, scars often form. Scars, which are areas of thick, discolored skin, often develop after damaged skin causes cells to die. The body produces a protein called collagen to repair the damaged skin, which leads to a scar.
Burn scars can be large or small depending on how much of the skin is damaged. The severity of the burn will determine whether these scars will fade or remain permanently visible.
In this article, we look at which types of burn are more likely to scar, how to reduce burn scars, and how to prevent long-term scarring from a recent burn.
Types of burn scars
Blisters may form in second-degree burns.
The likelihood and severity of getting a burn depend on how long a person is exposed to the heat as well as its intensity.
Burns are classified depending on how much of the skin they affect:
- First-degree burns damage the outer layer of the skin (the epidermis) and cause redness and pain. They usually heal within 6 days without scarring the skin.
- Second-degree burns affect both the epidermis and the layer under the skin (the dermis). As well as pain and redness, people with second-degree burns may experience blisters. These burns may take 2 to 3 weeks to heal and are more likely to scar.
- Third-degree burns are the most severe. They damage the top two layers of skin but may also damage the bones and tendons and can affect nerve endings. People with third-degree burns may also notice their skin turn white or black. These types of burns can take a long time to heal and are likely to produce a scar.
Scars caused by second and third-degree burns are categorized according to their appearance and how they affect the skin:
- Hypertrophic scars may appear red or purple and are raised above the skin level. They may feel warm and become itchy.
- Contracture scars make the skin, muscles, and tendons tighter and restrict normal skin movement.
- Keloid scars form a shiny, hairless bump.
Removing burn scars
Silicone gel can be applied to a burn scar to promote healing.
Quick treatment and proper wound care is often the best way to prevent or minimize the appearance of scars.
Many scars fade over time. However, keloid scars often do not fade by themselves and may require treatment.
Once a scar has already formed, a person can reduce the appearance of the scar by:
- Applying a silicone gel. Research shows that this can help to reduce the appearance of existing scars, including reducing the size, stiffness, and redness.
- Protecting the area from the sun. Ultraviolet rays from the sun can cause the scars to turn a darker color and become more noticeable. The American Academy of Dermatology (AAD) recommend that people wear protective clothing and sunscreen of SPF 30 or above.
- Be wary of over-the-counter scar removal products. The effectiveness of such products is often untested.
If burn scars cause significant distress, a person can talk to their doctor about options for reducing scar tissue. These treatments involve working with the damaged collagen.
The AAD recommend the following medical options for reducing scars:
- steroid injections, which may ease pain and reduce the size of keloid and other scars
- laser treatments, which can reduce redness, pain, and hardness of keloid and other scars.
- surgery to remove scar tissue, reducing the size of keloid scars and improving skin movement
While these treatments can help to reduce scars, they may not remove them completely, and healing can take time.
How to prevent scars
After a recent burn, a person can use several methods to prevent or reduce the severity of scars:
Directly after the burn occurs, a person can:
- rinse the burn with cool or lukewarm water, then let the skin air dry
- apply antibiotic anointment, using a sterilized applicator to help prevent infection
- cover the burn with a nonstick bandage, held in place with gauze
- seek medical care if the wound is getting redder instead of healing.
Shortly after the burn has healed, a person can:
- carefully stretch the skin around the affected area for a few minutes every day to prevent the skin from sticking together
- wait for any blisters to burst and drain by themselves, then have a doctor cut away the dead skin
- cover the damaged area with clothing or sunscreen for a few months
To ensure a severe burn is healing well make regular appointments with a doctor. They can advise on how to prevent or lessen scarring and check the burn is healing as it should.
How to treat burns
Applying gauze bandages to the burn will help to prevent infection.
Quick and proper treatment of a burn will reduce the risk and severity of any scarring.
A person can usually treat a first-degree burn at home by soaking the burn in cool water for a minimum of 5 minutes.
People who have a second-degree burn should usually see a medical professional. However, people can treat small burns at home in the following ways:
- Antibiotic ointment. Applying a thin layer of antibiotic ointment to the affected area promotes healing and reduces the risk of infection.
- Gauze bandages. Covering the burn with sterile, nonstick gauze protects the skin and reduces the chances of an infection.
Third-degree burns are very serious and require immediate medical attention.
Treatment for third-degree burns include:
- Compression garments are tight items of clothing that support the affected area. This pressure will allow the skin to recover. A person may have to wear a compression garment all day for a few months to give the burn time to heal.
- Skin grafts. A skin graft involves a surgeon taking healthy skin from another area of the body, or from a donor, and using this to cover the area of burned skin.
- Surgery. If a burn causes parts of the skin to stick together (called contractures), a person may require surgery to release these and enable movement.
- Physical therapy to encourage motion in areas of the body affected by contractures may also help.
If a burn does not heal within a week, regardless of its size or severity, make an appointment with a doctor. If the burn scar is severe or it does not fade in time, a person should also consult their doctor.
Applying aloe vera gel, eating a diet rich in antioxidant foods, drinking plenty of water, and taking certain supplements may improve a person's healing process. However, it is essential to consult a doctor before putting anything on severe burns and taking new supplements as these may interfere with other treatments.
The majority of minor burns will heal without causing any further problems and do not require medical care. More severe burns need medical management, may leave scars, and carry a higher risk of complications, such as:
Burns cause open wounds where bacteria and other germs can enter the body. The resulting infections can be minor and easily treatable or can develop into more severe infections, such as sepsis. Sepsis occurs when the infection enters a person's bloodstream and can be life-threatening.
Burns cause the body to lose fluid. Losing excessive amounts of fluid can cause dehydration, which can affect the volume of blood flowing through the body.
Low body temperature
A person's skin helps to regulate their body temperature. When a burn damages the skin extensively, the resulting heat loss can result in hypothermia, when a person's body temperature suddenly drops to dangerously low levels.
Contractures occur during the healing process when scar tissue forms. The scar tissue can tighten the skin, causing restricted movement in bones or joints.
Muscle and tissue damage
More severe burns often penetrate all the layers of a person's skin and can reach the muscles and tissue, which can cause long-term damage to these structures.
Self-esteem and emotional issues
Burn scars can harm a person's self-confidence or self-esteem, particularly when they are in an area that is not easy to hide, such as the face. This can lead to emotional and psychological distress.
The outlook depends on the severity of the burn is and how quickly treatment is given. Small first-degree burns should heal by themselves with little to no scarring. Second and third-degree burns may leave scars though treatment, such as skin grafts and pressure clothing, can help to reduce their visibility and encourage faster healing.