Why burn scars itch and how to find relief

As many as 90 percent of burn patients report itching after their injuries, according to data cited by the Phoenix Society for Burn Survivors. Itching usually subsides over time, but more than 40 percent of one study’s participants reported long-term itching after their initial burn.

Chronic itching on a burn wound is annoying and can be tough to control. But there are treatment methods that have helped relieve our patients’ symptoms at the Burn Center. Let’s discuss why burn wounds itch, available treatments and what our researchers are doing to relieve post-burn itching for future burn patients. 

What causes burn scars to itch?

Itching is known medically as pruritus. Itching often is caused by a substance called histamine. Histamine is a key part of the body’s immune system. It produces many of the symptoms we associate with allergic responses, including swelling, rashes and itchiness.

In this process, your body recognizes some foreign agent — something you’re allergic to, such as pollen or grass — on your skin. That causes your immune system to fight off the invader and release histamine, which causes itching.  

Some itching after a burn is a normal part of the healing process. But itchiness at burn scars isn’t caused by histamine. In this form of itching, nerves misreport an itch on the skin at the burn site, but the irritation actually is coming from the central nervous system. This is a condition known as central itch — basically an internal itch that can’t be scratched. A bigger or more serious burn doesn’t necessarily lead to worse itching at the scar. 

What treatments provide relief for burn scar itching?

The traditional treatment for itchiness is antihistamine. But because central itch isn’t caused by histamine, antihistamine pills and most itch-relief creams won’t always help.  

It may be tempting to scratch an itchy burn wound or scar, but that’s not a good long-term solution. In fact, scratching can damage fragile, healing skin, which is a particular concern for patients who have had skin grafts to treat burns.  

Some of my patients find relief with lidocaine ointment. Lidocaine can temporarily numb the area of skin where it’s applied. Other patients look to alternative treatments to relieve the itch, including:

  • Acupuncture
  • Hypnosis
  • Massage
  • Reiki therapy (a Japanese technique for relaxation and stress relief)  

Many of these alternative therapies help patients focus on something besides the itching. They don’t eliminate the sensation, but it’s not as persistent or top-of-mind as it ordinarily would be.

Some patients can’t find anything that helps with the itch and just live with it. For others, their itchiness comes and goes. There hasn’t been much research on why the symptom varies and what we can do about it — until now.  

If you have itching at a burn site that persists for months or years afterward, talk to your doctor about your treatment options and whether you need a referral to a burn specialist. 

New research into treating burn scar itching

Our early research into burn care focused on emergency care and preventing infections. We’re now turning our attention toward techniques for patients who are living with burn scars after treatment. We’re just starting to get data from patients who have lived with burn scars for 10, 15 or even 20 years. This information will guide our future treatment decisions.  

As of December 2016, we’re enrolling patients in a study to test a medication we could potentially use to treat central itch. We registered the study’s first participant nationwide just before the holidays in 2016, and we’ll be signing up more participants soon.  

We hope to better understand in the coming years why post-burn itching happens and what we can do to stop it. For now, pain-relieving medications and alternative techniques are our best weapons against itchy burn scars. 

Burn Center Director, MedStar Washington Hospital Center;  
Director of Burn Research, MedStar Health Research Institute 

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