Scars form from disorganized collagen fibers being laid down, which gives it a different texture and appearance than when normally laid down in an organized manner.
Less severe burns heal in less than 14 days with no scarring. Severe burns heal in 14-21 days with a high risk of scarring. Burns that take more than 21 days to heal are at a very high risk for scarring and may require skin grafting. Scars develop within the first few months after a burn, peak around 6 months, and resolve in 12-18 months. Scars mature and can fade in color, flatten, and be less sensitive.
Factors
- Age
- Ethnicity
- Depth
- Location
- Dermal or lower layer of skin being damaged
Hypertrophic scars
- Stay within the original burn injury location
- Develop within the first few months after a burn injury
- Often have a deep red to purple color
- Are raised above the surface of the skin
- May be warm to touch, hypersensitive, and itchy
- Are often more prominent around joints
Blisters
- Minimizing shearing on scars.
- Wearing loose clothing to minimize friction.
- Draining blisters with aseptic technique and using antibiotic ointments.
- Bandaging open blisters and avoiding adhesive or sticky bandages.
- Moisturizing.
Tears and Ulcerations
- Putting pressure on wounds until bleeding stops.
- Washing the area with mild soap and water.
- Using antibiotic ointments and nonstick dressing to allow the wound to heal.
- Watching for infection (red, warm).
- Contacting medical provider for recommendations and care.
- Keeping ulcerations covered with a thin film or antibiotic ointment.
- For ulcerations, keep surrounding skin well moisturized
- Continue exercise and stretch as appropriate
Scar Barriers
- Decreased mobility across joints -> contractures
- Body image issues leading to isolation, depression, and decreased quality of life
- Cause problems with skin being dry, cracking, or breaking down
- May be more sensitive, e.g., to the sun
Contractures
- Moisturizing skin first as recommended by a provider
- ROM and stretching multiple times per day
- Casting or splinting in a stretched position
- Functional activities to promote mobility such as ADLs
General Management
Promoting management of burns and scars with self-care or caregiver assistance:
- Stretching
- Taking medications and moisturizers as prescribed for pain and itching
- Keeping skin clean
- Avoiding hot showers and bathing which may remove natural oils from the skin
- Re-moisturizing
- Adding baby oil
- Scar pressure and massage for healing and desensitization
- Avoiding scratching
- Wearing off-the-shelf or custom pressure garments as prescribed, e.g., 23/24 hours per day
- Using silicone gel inserts over scars to decrease itching and dryness
- Wearing custom-made inserts under gloves and garments to increase the pressure on the scar and improve healing
- Avoiding sun exposure, wearing and reapplying sunscreen
- Surgical treatment as necessary and following up with the medical provider
References
Model Systems Knowledge Translation Center. (2019). Burn Injury Fact Sheet Booklet. Retrieved from https://msktc.org/burn/factsheets
Simons, M., King, S., & Edgar, D. (2003). Occupational therapy and physiotherapy for the patient with burns: principles and management guidelines. The Journal of burn care & rehabilitation, 24(5), 323-335.