Scar tissue fades over time for burn scars affecting the outer layers of the skin; however, the scars are more permanent for more severe burn injuries.

Burn injuries occur from the contact of excessive heat over the skin, causing tissue damage and often resulting in scarring. Whether a burn scar is permanent largely depends on the degree of the burn.

• Scar tissue diminishes over time for burns that just affect the outer layers of the skin. 
• In severe burns, when the skin's deeper layers are damaged, more permanent scarring develops, which can be thick, leathery, or uneven in appearance.

4 types of burn injuries

Depending on how deeply the heat has penetrated the skin, burn injuries can be classified into the following four categories:

1. First-degree burn: Also called a superficial burn, only the epidermis (the outermost layer of the skin) is affected. The burnt skin becomes red and painful, but no blisters are formed. An example of a first-degree burn is a sunburn.
2. Second-degree burn: Here, the heat penetrates a little more and damages not only the epidermis but also the dermis. There is a comparatively greater amount of redness and pain, and blister formation is seen.
3. Third-degree burn: In this, the heat destroys the epidermis and dermis and penetrates deep into the subcutaneous tissue. The burn site usually looks black and charred.
4. Fourth-degree burn: The most severe burn with the maximum amount of damage to tissue by heat where all the layers of the epidermis, dermis, and subcutaneous tissue, along with the underlying bones and muscles, are affected. This type of burn is painless because all the nerve fibers are destroyed; thus, they are not able to carry pain.

Why do burn scars form?

When part of the skin is burnt, all the cells present are charred and destroyed, resulting in newer replacement cells taking over the area.

Scar formation is nothing but a healing mechanism of the body in which to cover the destroyed part, the cells rich in collagen are formed in increased numbers to make a healed and thickened discolored area called a scar.

Three major types of scars

1. Hypertrophic scars: Raised from the surface and are reddish-purple
2. Contracture scars: Usually contract and tighten the skin, muscles, and tendons to cover up the area that was damaged
3. Keloid scars: Form shiny and hairless bumps that are raised from the skin, such as large tumors

Scar tissue formation is usually not seen in first-degree burns but is seen in second- and third-degree burns where there has been a significant amount of damage to the tissues. First-degree burns can result in pigmentation that usually fades.

5 treatment options for burn scars

The treatment depends on the degree of burns and the amount of skin tissue affected. There is no one-size-fits-all treatment of scars, which may take many years to see any improvement.

Nonetheless, treating burn scars may require the following options:

1. Pressure garments: Postburn irritation and scar formation may be reduced with custom-fit pressure garments. If you and your medical team decide to use tailored pressure garments, you should wear them 23 hours out of every 24 hours. Pressure garments can reduce itching and protect the skin from harm, even if they don't improve your scar.
2. Silicone gel sheets: These are thin, flexible strips of medical-grade silicone that are applied to scars to reduce itching and dryness. They're usually long-lasting and comfy to wear. They can be worn on their own or under compression garments, splints, or casts. Some people are allergic to silicone, so keep an eye on your skin for discomfort or rash.
3. Massage and stretching: Massage can aid in the softening and reduction of scars. Massage, when paired with stretching, can help loosen, soften, and comfort the scar and give mobility to the affected part.
4. Laser and surgical therapies: If scarring hinders from doing certain activities, surgical therapy, including laser treatment, may be a possibility.
5. Skin grafting: For smaller burns, a skin graft can be done, which is a form of plastic surgery.

First-degree burns don’t cause scarring. However, they can result in pigmentation that usually fades on their own, or the doctor can suggest cosmetic treatments to help them fade faster.

How do you prevent burn scars from forming?

Appropriate and prompt burn care of first- and second-degree burns can help prevent large scar tissue formation. Proper scar management by prevention is the best possible way to avoid a scar because once it is formed it’s very difficult to treat it.

It is typically difficult to prevent scar formation with third- and fourth-degree burns. Acute treatment of large third- and fourth-degree burns usually require hospitalization and intensive care unit care, as well as surgery.

The following burn care steps can aid in faster recovery and minimize scarring following first- and second-degree burn injuries:

• After the burn injury, rinse the area with cool water as fast as possible to nullify the effect of heat.
• Apply antibiotic ointment over it to prevent any secondary infection.
• Cover the burnt area with a clean bandage and stretch it for a few minutes daily to prevent wound contraction.
• If there is a blister formation, then let it pop on its own, and don’t let it expose to the sun to prevent excessive pigmentation.