Q: Dr. Eppley, I found a comment from you on the internet regarding burn scar revision. The reply seemed very honest regarding how to treat burn scars….meaning it is very difficult to treat and a 100 % elimination of it is not possible. My daughter is 14 years old and when she was 4 she was involved in a terrible accident, which left her with a 3rd degree burn scar on her forehead. Now the teenage years has begun and that is very difficult for her, as the focus from other teenagers constantly is her scar. We have tried laser surgery with limited success. The main challenge is the dark colour surrounded by a white scar colour and then the normal skin. What kind of solutions do you see, if any. Please let me know or perhaps I can sent you some photos. Thanks a million in advance for your reply from a very desperate father.
A: While I would need to see some pictures of the forehead scar to give a more definitive answer for your daughter’s case, I can make some general statements about burn scar revision. Burn scars are the most difficult of all scars to treat because they are broad-based and the involved skin, and sometimes the surrounding skin, is not normal. Pigment has been lost and the healed burned skin is not normal. There is just no way to ever make burned scar acquire pigment (the melanocytes in the skin layer has been lost) or achieve normal elasticity. Some texture changes in the skin may be possible by fractional laser resurfacing but you can not stimulate abnormal skin to become normal skin. The surrounding hyperpigmentation of the unburned skin can also be very difficult to eradicate. While some mild improvements may be possible with fractional laser resurfacing and pulsed light treatments, significant changes are not usually seen and the results will always be less than what any patient desires. In some cases, the burn scar is more linear and it may be able to be excised back to normal skin. There will always be a scar but this type of burn scar revision makes for more significant improvement.
Dr. Barry Eppley
Q: I have a burn scar on my leg from several years ago. I am sending a picture of my burnt leg, which I can stretch and bend easily meaning I can move it freely. I would like to know what you can suggest for getting the best scar result. I have heard about scars and that its impossible to make them disappear. Thanks in advance.
A:Thank you for sending your picture of your leg burn scar. Burn scars (deep 2nd and degree burns) create the worst outcomes in terms of eventually doing much with the scar because they have changed the entire thickness of the skin into one complete scar. The tissues are just never normal and do not have the ability for much normal tissue regeneration.
The good news is that you can move your leg freely without scar contracture or restriction. The bad news is that I don’t believe there is anything that will provide a substantial improvement in its appearance by any form of scar revision. Hypertrophic burn scars have changed the entire thickness of the remaining skin into one large white scar. It may be possible to get some improvement with combined fractional and CO2 laser resurfacing but the improvement may not be significant enough to justify the effort. That form of laser treatment may make it a little flatter but it will not make the scar disappear nor make it look like normal skin. Those goals are not possible. If the objective is some level of improvement then such effort may be worth it. But if the objective is to make it look like there is no scar there then any form of treatment should not be pursued as disappointment will surely follow.
Dr. Barry Eppley