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. 

Why We Must Address the Psychological Impact of Burns

Survival rates for burn patients have improved drastically over the years thanks to advances made in burn treatment. Unfortunately, the physical needs of patients often overshadow their emotional needs.

As more patients survive their injuries and return home, we must direct more energy toward efforts to reintegrate patients into society and home and treating the psychosocial effects of burn injuries. The emotional trauma caused by a burn can affect all parts of a person’s life: put stress on relationships, lead to depression or substance abuse, and even put additional strain on their physical health.

According to a study in Neuropsychiatric Disease and Treatment, stress disorders, including post-traumatic stress disorder (PTSD), are reported in as many as one-third of burn patients. These problems can develop up to a year or more after the injury. And these aren’t just people who had severe burns. Even a moderate burn that didn’t require much treatment can be emotionally devastating.

A few years ago, a patient of mine brought into sharp focus the challenges that accompany helping someone deal with the emotional side effects of a burn injury. This experience caused me to ask myself how my team could better address that aspect of the burn recovery process and ultimately led to a new position on our staff – a dedicated psychologist for The Burn Center.

How burns can take a psychological toll

Along with the physical pain of burns and the treatments they may require, patients also may face psychological stressors, such as:

  • Changes in body image
  • Depression
  • Family problems
  • Financial concerns
  • Vivid memories of the accident

These stressors can manifest in many ways. For example, symptoms of PTSD can include:

  • Avoidance of places that are reminders of the accident (such as a burn center)
  • Difficulty sleeping or having nightmares
  • Flashbacks of the accident
  • Irritability
  • Loss of interest in previously enjoyable activities
  • Negative thoughts about oneself
  • Social withdrawal

If you or a family member are experiencing depression or PTSD symptoms or are struggling to adapt to life after a burn injury, know that you’re not alone. There are resources in your community to help. Talk to your doctor about your options.

Just as physical recovery occurs in stages, psychological needs differ over time as well. Patients often are elated when it’s time to go home. However, that also tends to be when they start to melt down. They didn’t expect the stares they would get. Food doesn’t taste the same. Families didn’t realize the amount of care their loved one would need.

We try to help patients manage expectations while in the hospital. For example, we may tell them, “Your skin is never going to look the same again.” But these statements don’t always sink in because they’re grappling with everything else going on in that moment. In the back of their heads, they think that one day they’ll take off their compression garment and everything will look like it did before. When they realize this is never going to happen, it can be devastating emotionally.

Clinical challenges of treating the psychological side of burn injuries

Coordinating psychological care for burn patients is challenging, as was highlighted by my patient a few years ago. As an electrician, he suffered an electrical burn. We treat quite a few electricians and powerline workers with these types of burns, which can cause neuropathic pain for years despite all tests coming back normal. They require care from a neuropsychologist.

Because neuropsychologists are so specialized, they may not address depression or PTSD, instead focusing on the patient’s physical pain. So the patient also may need a psychologist to provide psychotherapy or a psychiatrist to prescribe medication. Coordinating this interwoven care can become immensely difficult. And community-based mental health centers often are unable to provide such complex care for these specific needs.

This was the challenge we faced with my patient. He had developed depression and substance use issues after his burn injury, and his relationship with his wife and children had become strained.

It took seven months to line up care to address his emotional issues. That was too long. I knew we had to do more.

How we treat the emotional side of the burn recovery process

Along with the after-care programs and services we offer, we’re also one of 60 Phoenix Society SOAR (Survivors Offering Assistance in Recovery) hospitals. The Phoenix Society is a not-for-profit founded by burn survivors. Many of our therapists are certified to train past patients to become peer supporters. These volunteers meet with patients one-on-one and lead group sessions.

Thanks to funding from organizations such as the DC Firefighters Burn Foundation, we also provide opportunities to attend adaptive recreation trips, in which an activity such as cycling or canoeing is adapted to accommodate a person’s specific needs.

Because a burn patient’s PTSD likely will manifest differently from someone who experienced another type of trauma, we shouldn’t treat them the same. Unfortunately, there just isn’t a lot of research and data to guide us in effectively treating the psychosocial side of burn injuries.

To help change that, we created a position within The Burn Center for a full-time psychologist. This person will provide more specialized, coordinated care for burn patients as well as study and develop best practices to treat psychosocial health from the moment of admission through treatment and beyond.

I expect this to be just the tip of the iceberg. At any given time, 50 to 70 percent of our burn patients are eligible to enroll in a clinical trial. I expect these numbers to increase over the years as we include trials geared toward psychosocial health and reintegration into society and home.

As one of only a handful of burn centers in the country to have a dedicated psychologist on staff, I’m positive we can make an impact in this important emerging field of study.