What is the best cream for managing burn scars?

Best Creams for Managing Burn Scars

Silicone-based products are the most effective first-line treatment for managing burn scars, with silicone gel sheets or topical silicone gel showing the greatest efficacy for improving scar appearance and reducing symptoms. 1

Evidence-Based Treatment Options

First-Line Treatments

1. Silicone-based products

   • Silicone gel sheets: Highly effective for flat areas of the body 2, 1
   • Topical silicone gel: Particularly beneficial for joints and areas where sheets may not adhere well
   • Benefits: Significantly improves surface roughness (p=0.012) and reduces itching (p=0.018 at 3 months) 1

2. Moisturizers/Emollients

   • Apply regularly to keep the scar hydrated
   • Water-in-oil emollients are recommended over occlusive ointments 3
   • Application technique: Use latex-free gloves or single-use packets to avoid contamination 3

Second-Line Treatments

1. Aloe vera-based products

   • Shows significant improvement in scar parameters including scaliness (+22%), softness (+14%), and roughness (+16%) 4
   • Rated as "best of three" by most study participants when compared to dexpanthenol and plant oil 4

2. Dexpanthenol-containing creams

   • Improves baseline firmness parameter by +14.7% (p=0.007) 4
   • Beneficial for improving roughness and volume parameters

Treatment Algorithm Based on Scar Type

For Fresh/Immature Burn Scars (0-6 months)

1. Begin with gentle cleansing and application of non-adherent dressings
2. Once wound is closed, apply silicone gel or sheets daily
3. Apply moisturizer (preferably aloe vera-based) multiple times daily
4. Leave blisters intact to improve healing and reduce pain 5
5. Cover with sterile, non-adherent dressing applied loosely 5

For Mature Hypertrophic Scars (>6 months)

1. Continue silicone gel/sheets as primary treatment
2. Consider massage therapy, which shows highest efficacy in reducing Vancouver Scar Scale scores (SUCRA = 89.0%) 6
3. For thicker scars, CO₂ laser therapy may be considered as it shows highest efficacy in decreasing scar thickness (SUCRA = 96.8%) 6

Application Guidelines

• Silicone products: Apply for 12-24 hours daily for at least 2-3 months
• Moisturizers: Apply 3-8 times daily 3
• Duration: Continue treatment for at least 28 days to see significant improvement 4

Important Cautions

• Avoid products containing urea, salicylic acid, or silver sulfadiazine on healing burns due to risk of percutaneous absorption 3
• Monitor for signs of infection, especially in recently healed burns
• For severe or extensive scarring, consider referral to a burn specialist
• If mucous membrane involvement or blistering is noted, consider early admission to a burn center 3

Special Considerations

• For burn scars with pain, consider extracorporeal shock wave therapy in addition to routine treatment, which shows highest efficacy in reducing pain scores 6
• For scars on face, hands, feet, or genitalia, seek immediate medical attention regardless of size 5
• For children with >10% TBSA burns or adults with >20% TBSA burns, specialized care is recommended 5

The evidence clearly demonstrates that silicone-based products should be the cornerstone of burn scar management, with appropriate moisturizers as adjunctive therapy. Regular application and patience are essential, as significant improvements may take several months to become apparent.