Shriners Hospitals for Children® – Boston is on the leading edge of burn care because of our pioneering efforts in modern scar treatment, which begins immediately after the wound heals. One of our key treatment tools is the pulsed-dye laser, whose beam stimulates healing within the skin. This improves the appearance and symptoms of scars, including keloids.
Preventing Scar Formation
Scars are a natural and essential part of the healing process. While they help to protect wounds from additional physical damage, they are not necessary and are often unsightly once a wound closes. Scars, including keloids, develop following burns, cuts and surgery and as a result of diseases such as acne. After the wound closes, a scar is visibly noticeable because scar tissue, unlike natural skin tissue, does not regenerate.
Normal, undamaged skin is made of a layer of collagen fibers that lie underneath the skin, parallel to the skins’ surface. The skin applies pressure against these underlying layers, allowing the skin to remain flat and smooth. When a minor injury occurs, the pressure that the skin puts on the body helps the injured skin heal back to its original state without scarring.
When a child is severely burned, the skin and the underlying collagen layers are destroyed. Pressure garments help prevent the development of hypertrophic, or raised, scars and keep scar tissue soft by applying pressure to the wounded area. Since scar tissue is very responsive in the early stages of formation, it’s important to begin wearing pressure garments as soon as possible.
Using pressure to prevent scar formation can range from a full-cloth body suit to a pliable-plastic mask worn just over the face.
Wearing Pressure Garments
Proper fitting garments are critical to success, so each patient’s pressure garments will be measured individually. Garments that are too tight can cause numbness or tingling, or abrade the skin. Garments that are too large will not apply enough pressure to be effective.
Pressure garments may be worn from as short as a few months to as long as two or three years, depending on the severity of the burn and the area of the body that is affected. The garments are worn 23 hours a day, seven days a week, and are removed only for bathing and when they interfere with therapy. In most cases, it’s a good idea to have two sets of garments on hand so that a clean set is always available for wear.
When pressure garments are part of your child’s burn therapy, your doctor will give you specific and personalized instructions about how your child should wear them and how long they should do so.
Understanding Keloid Scarring
Keloids are disfiguring scars that can impair the quality of life of burn survivors. Unlike normal scars, keloids are overgrowths of scar tissue that spread to adjacent skin and resist treatment. It is not clear why only some patients are at risk for keloid formation, which is more prevalent among darker-skinned individuals and younger patients.
Dorothy Supp, Ph.D., a researcher at Shriners Hospitals for Children-Cincinnati, is the lead investigator of a project to discover and understand the molecular basis for keloid scarring in order to develop more effective treatments. She became interested in keloid scarring because of a patient with a particularly severe case. “One of our plastic surgeons asked if we could do something to figure out why this happens,” she said.
Supp and her team have analyzed which genes are turned on or off in keloid skin cells compared to normal skin cells. They identified some key differences that can help shed light on why cells in keloids give rise to abnormal scars. The researchers have also created models of keloid scars that will be used to test other potential treatments. By advancing our understanding of keloid formation, novel therapies can be developed, leading to improved functional outcomes and enhanced quality of life for burn survivors.
This project is one of 41 research initiatives related to developing a better understanding of burn injuries and treatment currently being funded by Shriners Hospitals for Children.