What Are The Treatments For Burn Scars After Wound Healing?

A study by Deitch and colleagues, published in 1983 in "Journal of Trauma," studied 100 patients and found a 38 percent prevalence of pathological scars following a burn injury. Hypertrophic scars can occur in any race and any age; they remain within the boundary of the original injury but are raised and often red. They may itch or are painful and can regress spontaneously. Hypertrophic scars are fairly common after a burn or scald.

Compression Garments

Compression can be applied through a number of means, for example, elastic bandages, thromboembolic stockings, or specially designed garments. The pressure is thought to reduce tissue metabolism. The garments must be worn 24 hours for 6 to 12 months and success varies.

Silicone Gel

Silicone gel is thought to improve scars by hydrating the wound or altering growth factor expression. It can be used alone, or with compression garments. Silicone gel must be used for 12 hours a day, for up to 12 months. Side effects can include a rash and wound breakdown. Li-Tsang and colleagues, in the "Journal of Burn Care Research " in 2010, published a randomised controlled trial, which showed that silicone gel used alone was effective in reducing hypertrophic scar symptoms such as pain and itching. However, they also showed that silicone gel used with pressure garments showed improvement in both scar thickness and symptoms.

Intralesional Injections

Corticosteroids, such as triamcinolone acetonide, can be injected into the scar. They cause flattening of the scar and can reduce symptoms such as itching or pain. Side effects include a loss of pigmentation (hypopigmentation), and subcutaneous atrophy. Triamincinolone can also be given in combination with anti neoplastic drugs, such as 5 Fluorouracil. The injections can be painful. They can achieve flattening of the scar and reduce symptoms but side effects can include discoloration and ulceration.

Surgery

Surgical revision of pathological scars can be performed, but there is a high rate of recurrence. Many surgical techniques have been devised to reduce recurrence. Often surgery is followed by other treatments, such as compression garments or intralesional injections, to reduce recurrence of the scarring.

Future Therapies

A number of new therapies are currently being assessed for the treatment or, prevention of pathological scars. These new therapies may alter growth factors or inflammation (e.g. tacrolimus), thought to cause the overactive healing in these scars. Other therapies, such as Verapamil, prevent the over-production of collagen; or modify cell metabolism (retinoic acid).