Except for the superficial dermal burns, all deeper burns like deep dermal and full thickness heal by scarring. This scarring can only be minimised by various physical therapy measures and plastic surgical procedures but not eliminated completely The scarring may be hypertrophic, keloid, stable or unstable, depigmented or hyperpigmented
The scars may turn malignant as well. The post-burn scars are inevitable in deeper burns in case early tangential excision and skin grafting has not been done. If such burns are treated with dressings alone,they eventually heal with contraction resulting in Burn scar contracture . When skin is burned, the surrounding skin begins to pull together, resulting in a contracture. It needs to be treated as soon as possible because the scar can result in restriction of movement around the injured area and can cause disability if it happens to be on a joint surface. Most of these patients also complain of itching on the healed burn and split-skin donor sites and need prescription of antihistaminic drugs at least at bed time. Itching must be prevented not only to make the patient comfortable but also to break the cycle and ulceration.
The burn scars can be managed with moisturizing lotions, pressure garment therapy, silicon sheet treatment, application of silicon gels, etc. Latest modalities are fractional laser treatment of burn scars and fat injection into the scars. However if there is scar contracture which is restricting the movement of a joint,it needs excision and skin grafting followed by physiotherapy.Very severe hypertrophic scars which are not responding to other treatments,may also need skin grafting.