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Health condition · Clinically reviewed

Burns and scars, from silicone and steroid to laser, surgery and long-term care.

Scars are treatable. The right ladder - silicone, pressure, steroid, laser, surgery and physio - restores function, softens texture and helps confidence return.

Jump to treatment
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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BAPRAS, British Burn Association, NICE and peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK practice including silicone-first prevention, intralesional triamcinolone and fractional laser resurfacing.

Key facts

Burns and scars at a glance.

The essentials, in plain English - the main scar types, what to try first, and when to escalate to a specialist.

  • What it covers

    Scars from burns, surgery, trauma, acne and inflammation - hypertrophic, keloid, atrophic, contracture and pigmentary types.

  • Scar types

    Normal, hypertrophic, keloid, atrophic, contracture, striae (stretch marks) and post-inflammatory pigmentation - each has a different treatment ladder.

  • Post-burn scarring

    Contractures across joints, pruritus, hypersensitivity, temperature and sensory changes - functional, cosmetic and psychological all matter.

  • First-line prevention

    Silicone sheeting or gel, moisturisation, gentle massage, SPF50+ and - for burns - pressure garments for three to nine months.

  • First-line hypertrophic and keloid

    Intralesional triamcinolone 10 to 40 mg/mL every four to six weeks for three to six sessions, plus silicone.

  • When to escalate

    Laser, microneedling, surgical revision, tissue expansion or adjuvant radiotherapy for high-risk keloids - all specialist-led.

Why this guide matters

A whole-person ladder, not one treatment.

Scar care is layered - prevention, medical, procedural, surgical and psychological. The three points below shape everything else on this page.

  • Prevention beats revision

    Silicone, sun protection, pressure garments and gentle massage in the first 6 to 12 months prevent most severe scars.

  • Match the treatment to the scar

    Hypertrophic and keloid want steroid and silicone. Atrophic wants laser or microneedling. Contracture wants surgery and physio.

  • Function and feelings both matter

    Range of movement, itch, pain and body image are all part of the outcome - and all treatable.

How scars are assessed

From first look to a clear plan.

A structured assessment - VSS, POSAS, mapping, function and psychosocial impact - so treatment matches the scar and the person.

  1. 01

    Describing

    Scar history and mapping

    Cause, age of the scar, symptoms and previous treatments - mapped and photographed so change can be measured.

  2. 02

    Describing

    Vancouver Scar Scale (VSS)

    A clinician-rated score for pigmentation, vascularity, pliability and height - a shared language for how a scar is behaving.

  3. 03

    Describing

    POSAS - patient and observer

    The Patient and Observer Scar Assessment adds the patient voice - pain, itch, colour and how the scar feels.

  4. 04

    Impact

    Function, range and sensation

    For contractures across joints - range of motion, strength, sensation and any hypersensitivity or dysaesthesia.

  5. 05

    Impact

    Cosmetic and psychosocial impact

    Body image, confidence, avoidance and mood - scars carry a real psychological load that deserves naming.

  6. 06

    Monitoring

    Serial photography

    Standardised photographs at each review make it possible to see progress that day-to-day looking hides.

  7. 07

    Monitoring

    Specialist referral

    Plastic surgery, dermatology or a specialist scar clinic for keloids, contractures or complex reconstruction.

Typical pathway: assessment, staged treatment and review over 6 to 24 months.

Scar types

The scars you might see - and what they mean.

Normal, hypertrophic, keloid, atrophic, contracture, striae and pigmentation. Each behaves differently - and each has a different treatment ladder.

  • Normal (mature) scar

    Flat, pale, soft - the end-point of good healing. Fine line, no itch, no functional impact.

  • Hypertrophic scar

    Raised, red, itchy - stays within the original wound boundary and may soften and flatten over 12 to 24 months.

  • Keloid scar

    Extends beyond the original wound, does not regress, more common in darker skin - ear lobes, chest, shoulders and neck are typical sites.

  • Atrophic scar

    Depressed or pitted - post-acne, chickenpox and some surgical scars. Ice-pick, boxcar and rolling subtypes.

  • Contracture scar

    Tight, thickened band - usually post-burn - that shortens across a joint and restricts movement or opening.

  • Stretch marks (striae)

    Linear striae from rapid growth, pregnancy, weight change or steroid use - red at first, silvery-white when mature.

  • Post-inflammatory pigmentation

    Darker (hyperpigmentation) or lighter (hypopigmentation) patches after inflammation - common in skin of colour.

  • Red flag - contracture and pain

    Loss of joint range, tethering, neuropathic pain, chronic ulceration or rapid keloid growth - warrants specialist review.

Post-burn specific

Burns leave more than a scar.

Contractures across joints, cosmetic disfigurement, psychological trauma, functional restriction, chronic itch (pruritus), hypersensitivity, temperature-regulation problems and altered sensation are all common after significant burns. Each is treatable - and worth naming so it can be treated.

Treatment

How burns and scars are treated in the UK.

A stepped ladder - silicone and pressure first, then steroid injection, laser, microneedling, surgery and physio - all supported by psychological care.

  • Silicone gel and sheeting

    First-line preventive and treatment for hypertrophic and keloid scars - worn 12 to 23 hours a day for two to six months.

  • Pressure garments (Jobst)

    Custom-fitted for burn scars and large hypertrophic scars - worn three to nine months to flatten and soften.

  • Massage, moisturisation and SPF50+

    Daily massage, emollients and strict sun protection - simple habits that make every other treatment work better.

  • Intralesional triamcinolone

    First-line for keloid and hypertrophic scars - 10 to 40 mg/mL every four to six weeks for three to six sessions.

  • 5-fluorouracil, verapamil, bleomycin

    Adjuncts to steroid injection for stubborn or recurrent keloids - specialist-led selective use.

  • Pulsed dye laser (PDL)

    Reduces redness, thickness and itch in hypertrophic and immature scars - typically three to six sessions.

  • Fractional CO2 or Er:YAG laser

    Resurfaces atrophic, contracture and post-burn scars - improves texture, pliability and colour over a series.

  • Microneedling and Morpheus8 RF

    Collagen induction and radiofrequency microneedling for atrophic acne scars, striae and mild contour irregularity.

  • Subcision, PRP and fillers

    For tethered rolling atrophic scars - releases the scar floor and adds volume for a smoother surface.

  • Cryotherapy

    A useful option for small, isolated keloids - often combined with intralesional steroid.

  • Surgical revision

    Z-plasty, W-plasty, geometric broken-line closure, excision, skin grafts, tissue expansion or flap reconstruction.

  • Adjuvant radiotherapy

    Post-excision radiotherapy for very high-risk keloids - highly selective, specialist plastic surgery and clinical oncology decision.

  • Botox for hyperactive scars

    Reduces tension across a healing scar to improve final cosmesis - useful on the face and around joints.

  • Physiotherapy and OT

    Range of motion, splinting, scar massage, desensitisation and oedema management - the backbone of burn scar recovery.

  • Psychological support

    CBT, body-image work and charities such as Katie Piper Foundation, Changing Faces and Dan’s Fund for Burns.

  • Specialist scar and burn clinics

    UK burn units, plastic surgery scar clinics and dermatology-led scar services for complex or high-risk scars.

Explore treatment

Pulsed dye laser (PDL)

For redness, immature hypertrophic scars and vascular scar itch.

Explore treatment

Fractional CO2 laser

Resurfacing for atrophic, contracture and post-burn scar texture.

Explore treatment

Plastic surgery reconstruction

Z-plasty, grafts, tissue expansion and flap reconstruction for contracture.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, plastic surgeon or dermatologist knows your skin and history and can tell you which parts apply to you. If in doubt, get seen.

  • British Burn Association. National standards for provision and outcomes in adult and paediatric burn care.

  • BAPRAS. British Association of Plastic, Reconstructive and Aesthetic Surgeons - scar management guidance.

  • NICE. Guidance on scar management and dermatological procedures.

  • International clinical recommendations on scar management (updated consensus).

  • MHRA. Guidance on the use of intralesional corticosteroids and adjuvants in scar treatment.

Red flags

When a scar needs urgent attention.

Most scars are manageable in primary care and outpatient clinics. These are the situations where a specialist opinion should not wait.

  • Contracture across a joint

    Any burn or surgical scar that limits movement, tethers skin or shortens across a joint needs early plastic surgery and OT review.

  • Rapidly growing keloid

    A scar that keeps enlarging beyond the original wound, especially on the chest, shoulder, ear or jaw, deserves a specialist opinion.

  • Chronic non-healing scar

    A scar that ulcerates, breaks down or fails to heal - consider infection, poor perfusion or, rarely, malignant change (Marjolin ulcer).

  • New change in an old burn scar

    A long-standing burn scar that changes, ulcerates or grows warrants biopsy to exclude Marjolin ulcer.

  • Severe pruritus or neuropathic pain

    Persistent itch, burning or shooting pain in a scar - treatable, but often under-recognised. Ask for help.

  • Psychological distress

    Low mood, avoidance, social withdrawal or body-image distress after a burn or visible scar - a real clinical problem, not vanity.

  • Infection or dehiscence

    Redness, discharge, warmth, wound breakdown or systemic upset in a healing scar - see a clinician urgently.

  • Loss of temperature sensation

    Post-burn skin that cannot regulate temperature or feel heat - a burn hazard that needs education and protection.

  • Suspected skin cancer in scar

    Any new lump, nodule, non-healing area or unusual pigmentation in a scar - refer for specialist assessment.

Living with it

A long game, with real progress.

Four things that make the biggest difference day to day - silicone, sun, movement and mental-health support.

A quiet reminder

Scars remodel for at least a year.

Small, steady habits - kept up for months - do more than a heroic week that doesn’t last.

  1. 01 Routine

    Silicone, sun and massage

    The three habits that quietly do most of the work - silicone gel or sheeting, SPF50+ every day and gentle daily massage.

  2. 02 Patience

    Give scars 12 to 24 months

    Scars remodel for at least a year. Judge progress in seasons, not weeks - and take photos.

  3. 03 Function

    Move it to keep it

    Range of motion, splinting and physiotherapy protect movement after burns - especially across joints.

  4. 04 Mind

    Ask for help early

    Body-image support, CBT and peer networks (Katie Piper, Changing Faces, Dan’s Fund for Burns) help - use them.

Frequently asked

Everything we get asked about burns and scars.

Quick answers on scar types, silicone, steroid injection, laser and post-burn care.

  • What is the difference between a hypertrophic scar and a keloid?

    A hypertrophic scar is raised and red but stays within the boundary of the original wound and may improve over 12 to 24 months. A keloid grows beyond the original wound, does not regress on its own and is more common in darker skin, on the ear lobes, chest, shoulders and neck.

  • What is the first thing to do for a new scar?

    Keep it moisturised, protect it from the sun with SPF50+, and once the wound has closed apply silicone gel or sheeting for 12 to 23 hours a day for two to six months. Gentle daily massage helps pliability. For burn scars, add a custom pressure garment.

  • Do steroid injections work for keloids?

    Intralesional triamcinolone 10 to 40 mg/mL every four to six weeks for three to six sessions is first-line for keloid and hypertrophic scars. It flattens, softens and reduces itch. Stubborn scars may need 5-fluorouracil, cryotherapy or surgical excision with adjuvant radiotherapy.

  • Can lasers really help scars?

    Yes - but the right laser for the right scar. Pulsed dye laser reduces redness and itch in hypertrophic scars. Fractional CO2 or Er:YAG resurfaces atrophic acne scars, contractures and post-burn scars. Nd:YAG and IPL help pigmentation. Most people need three to six sessions.

  • What can be done for post-burn contractures?

    A combination of pressure garments, silicone, physiotherapy, splinting and specialist plastic surgery. Z-plasty, W-plasty, skin grafts, tissue expansion and flap reconstruction release contractures across joints and restore function. Botox is sometimes used to reduce tension across hyperactive scars.

  • Where can I get emotional support after a burn?

    The Katie Piper Foundation, Changing Faces and Dan’s Fund for Burns all offer peer support, counselling and body-image work in the UK. Ask your GP or burn unit for a referral to clinical psychology - it is a standard, funded part of burn recovery.

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