Do pressure garments and scar massage help burn scars?

What are hypertrophic burn scars?

Hypertrophic scars are raised, red, firm scars that stay within the boundaries of the original wound. They are common after deeper burns and burns that take longer to heal. They can be itchy, painful and tight, and may limit movement or affect appearance.

Most hypertrophic scars gradually soften and flatten over months to years as they mature.

How do pressure garments work?

Pressure garments are custom-made elastic garments that apply continuous pressure to healing scars. They are thought to reduce blood flow and collagen production in the scar, helping it become flatter and softer. They are usually worn for most of the day for many months.

Garments need regular measurement and replacement as they lose tension and as scars change.

What does the evidence show for pressure garments?

A meta-analysis of six randomised trials with 316 patients found no difference in global scar assessment between scars treated with pressure garments and control scars. Pressure garments produced a small, statistically significant reduction in scar height, but the difference was of questionable clinical importance 1.

There were no differences in scar vascularity, pliability or colour. The authors noted that the benefits remain unproven, while the potential discomfort and costs are not insignificant 1. Many burn services still use pressure garments, especially for larger scars, alongside other treatments.

Does scar massage help?

A systematic review of scar massage for hypertrophic burn scars included eight publications with 258 human participants. It found preliminary evidence that massage may reduce scar height, vascularity and pain, improve pliability, and decrease itching and depression 2.

The review highlighted the poor quality of available studies and a lack of consistent scar assessment tools, so more research is needed 2.

How is scar massage done?

Massage is usually started once the wound has fully healed and the skin can tolerate pressure. A therapist teaches firm, slow circular and stretching movements using a non-perfumed moisturiser, several times a day.

Massage should not cause blisters or skin breakdown. Newly healed skin is fragile, so pressure is increased gradually.

What else helps burn scars?

Other scar management approaches include silicone gel sheets or gels, moisturising, sun protection, stretching and splinting. For persistent problem scars, treatments such as laser therapy, steroid injections or surgery may be considered.

International burn care guidelines address rehabilitation and scar management as part of comprehensive burn care 3. Psychological support can help with the emotional impact of scarring.

What is silicone gel, and can it be used with pressure garments?

Silicone gel sheets and gels are commonly used on healed burn scars to keep the scar hydrated and may help it become flatter and softer. They are applied once the skin has healed and are often worn for many hours each day.

Silicone can be used under or alongside pressure garments in many cases. Therapists check the skin regularly, because heat and moisture under dressings can cause irritation or rashes.

How can the emotional impact of burn scars be addressed?

Burn scars can affect self-image, confidence and social life, especially on visible areas such as the face, neck and hands. Feelings of anxiety, low mood or avoiding social situations are common and understandable.

Psychological support, peer support groups and camouflage make-up services can help. Children and teenagers may benefit from school support and specialist groups for young burn survivors.

When should a scar be checked?

Seek advice for scars that open, blister, bleed or show signs of infection, or scars that are becoming tighter, more painful or itchier despite treatment.

A non-healing wound or changing lesion within an old burn scar should be assessed by a doctor.

Frequently asked questions