Silicone Scar Sheets for Burn Scars: Special Considerations for Burn Scar Treatment

Burn scars can significantly impact quality of life, causing not only cosmetic concerns but also discomfort, itching, and potential limitations in movement.

Silicone gel sheets have emerged as an effective non-invasive treatment option for managing burn scars, particularly for hypertrophic and keloid scarring.

This report explores the specific considerations when using silicone sheets for burn scar management, providing evidence-based guidance for optimal treatment outcomes.

Understanding Burn Scar Formation

Burn scars develop as part of the natural healing process when the skin repairs itself following thermal injury. However, in many cases, the healing process can become dysregulated, leading to abnormal scarring.

Types of Burn Scars

Hypertrophic scars are the most common type following burn injuries. They typically appear thick, wide, red, and raised compared to surrounding skin. These scars differ from keloid scars, which extend beyond the boundaries of the original wound. The severity of scarring depends on multiple factors, including burn depth, healing time, and individual characteristics.

A burn wound that heals within two weeks usually results in minimal scarring. However, wounds taking three weeks or longer to heal generally develop some form of hypertrophic scarring. Other factors affecting scar formation include skin tone, age, gender, and the location of the burn on the body.

How Silicone Scar Sheets Work

Silicone gel sheets are thin, flexible medical-grade silicone devices that are placed directly over healed scars. While their exact mechanism of action isn't fully understood, several theories explain their effectiveness:

Mechanism of Action

Increased Hydration: Silicone sheets occlude the skin, increasing hydration of the stratum corneum and regulating fibroblast production and collagen synthesis. This hydration helps restore the skin's barrier function and reduces roughness and flaking.
Growth Factor Modulation: They help balance the expression of growth factors, particularly fibroblast growth factor β (FGF β) and tumor growth factor β (TGF β), which play crucial roles in collagen production.
Protective Barrier: Silicone sheets protect the scar from bacterial invasion, preventing bacteria-induced excessive collagen production in the scar tissue.
Symptom Relief: They effectively reduce itching and discomfort associated with burn scars.

Clinical Evidence for Burn Scar Treatment

Research supports the efficacy of silicone gel sheets for burn scar management. A randomized, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars found that after 4 months of treatment, silicone gel significantly improved various scar characteristics compared to the control group.

In this study, all scar scale measures were significantly lower in the silicone gel group than in the control group after 4 months, except for the pain score. The results demonstrated that silicone gel is an effective treatment specifically for hypertrophic burn scars.

Other studies have reported up to 90% effectiveness in improving red, dark, or raised scars, including those resulting from burns. One particular study showed 86% reduction in texture, 84% in color, and 68% in height of scars.

Special Considerations for Burn Scars

Timing of Treatment Initiation

For burn scars, timing is crucial. Silicone therapy should begin when the wound has fully re-epithelialized and is no longer open:

For patients at increased risk of hypertrophic or keloid scarring, silicone therapy should start when full re-epithelialization is reached, typically within about 2 weeks of wound closure.
Silicone products can be used as soon as the wound has grown a thin covering of skin and is no longer open to the air.
Early intervention is key, as scar hypertrophy develops in most cases (96%) within a 3-month period after injury.

Application Duration and Protocol

The recommended application protocol for burn scars requires commitment:

Initially, apply for 2-3 hours per day, then gradually increase by 1-2 hours daily over a period of 1-2 weeks, allowing for washing periods.
For optimal results, silicone sheets should be worn for a minimum of 12 hours to a maximum of 23 hours per day.
The gradual build-up allows the skin to become accustomed to the silicone and minimizes potential adverse effects.
Total treatment duration should be at least 2-3 months, with a recommended 6-month period to prevent recurrence in severe cases.
For burn scars that stay in the immature phase for a prolonged period, treatment may extend beyond 6 months.

Combination Therapy for Burn Scars

Burn scars often benefit from a multi-faceted approach:

For deep dermal burns, combining silicone sheets with pressure garments may provide enhanced benefits.
Some studies show combined use of compression and silicones demonstrates more positive effects than either therapy alone, though evidence is mixed.
Custom pressure garments are typically worn 23 out of 24 hours per day alongside silicone therapy for severe burn scarring.
For severe scars resulting from deep dermal burns, referral to a specialized burn care unit for alternative and combined therapies may be necessary.

Practical Application Guidelines for Burn Scars

Preparation and Application

Ensure the area is completely healed with no open wounds.
Clean and thoroughly dry the scar area.
Cut the silicone sheet to the appropriate size, ensuring it overlaps the scar by at least 1 centimeter.
Remove the protective film and apply the silicone sheet over the scar. Avoid stretching when applying over a joint.
For burn scars specifically, do not apply ointments or creams under the gel sheet.

SILICONE SCAR SHEETS FOR BURN SCARS: PRACTICAL APPLICATION GUIDELINES

Maintenance and Care

Proper maintenance is essential, particularly for burn scars:

Remove the sheet three times daily for inspection, washing of the skin, and scar massage unless otherwise instructed.
Wash the gel daily in lukewarm water with mild soap, then air dry before reapplying.
For optimal hygiene, wash both the silicone sheet and the area of skin being treated once a day with hypoallergenic soap and clear warm water.
When not in use, return the silicone sheeting to its plastic backing and store in a cool place away from direct heat and sunlight.
Replace the sheet when adhesive properties are no longer sufficient, typically after 2-4 weeks of use.

Challenges and Complications in Burn Scar Treatment

Climate Considerations

In hot climates, special attention must be paid when using silicone sheets for burn scars:

A study of 25 Saudi patients with hypertrophic scars from burns or traumatic friction injuries found multiple challenges related to the hot climate.
Problems included persistent pruritus (80%), skin breakdown (8%), skin rash (28%), skin maceration (16%), and foul smell from the gel (4%).
Additional issues included poor durability of the sheet (8%) and failure of the sheet to improve hydration of dry scars (52%).

Managing Complications

Most complications can be managed without discontinuing treatment entirely:

For skin irritation, rash, or open/weeping areas, remove the gel temporarily and contact your healthcare provider.
Most problems can be eliminated by temporary interruption of treatment, more frequent washing of the gel sheet, better skin hygiene, and occasionally changing the brand of gel sheets.
For persistent irritation, build up skin tolerance slowly, starting with shorter wearing times.
In the study of Saudi patients, permanent discontinuation occurred in only one case due to lack of response to treatment.

Special Populations

Silicone gel sheets are safe for use on children as well as adults with burn scars.
They are particularly beneficial for pediatric patients who may not be able to tolerate other treatments like intralesional corticosteroid injections.
For patients with darker skin complexion, silicone therapy is especially important as keloid scarring is more common in darker skin.

APPLICATION TIMELINE FOR BURN SCARS WITH SILICONE SHEETS

Conclusion

Silicone gel sheets represent an effective, non-invasive approach to managing burn scars. Their success depends on proper timing, consistent application, and adherence to care protocols. For burn scars specifically, consideration of factors such as scar severity, climate, and potential combination with pressure therapy is essential for optimal outcomes.

While silicone sheets may not completely resolve all burn scars, evidence supports their role in improving scar appearance, reducing symptoms like itching and discomfort, and enhancing overall quality of life for burn survivors. The treatment requires patience and consistency, with results typically becoming noticeable after 2-4 months of dedicated use.

For severe or complicated burn scars, consultation with specialized burn care professionals is recommended to develop a comprehensive treatment approach that may combine silicone therapy with other modalities for maximum benefit.

Silicone Treatment for Scars

Monday, March 31, 2025

Silicone Scar Sheets for Burn Scars: Burn Scar Treatment