Scar Management Service
Scar Service - Birmingham Children’s Hospital Holistic Integrative Scar Service
After a burn or a traumatic injury, your child may develop a scar.
Our Scar Management Team provide holistic and specialist scar therapy to help improve the scars and to support you and your child through the process.
Firstly, the Burns Team will assess whether you need any further support or treatment during your scar maturation process, assessing and treating any abnormal scarring, and accessing the services that your child will need.
The Team is made up of Burns Care and Scar Management Consultants, Laser Specialists, Physiotherapists, Occupational Therapists, Play specialists, Camouflage experts, and Psychologists who will be involved with the care of your child as needed.
The following services are available:
- Pressure therapy
- Silicone therapy
- Splinting
- Intra-lesional steroid injections
- Hair restoration (tissue expansion) and hair removal
- Lasers
- Skin camouflage
- Surgical revision of scars
We provide face-to-face and telephone education, advice and support for patients and their families/carers
What is a scar?
A scar is a mark on the skin after a wound or injury has healed.
Scars are a natural part of the body's healing process. A scar results from the biological process of wound repair in the skin and other tissues. Most wounds, except for very minor ones, result in some degree of scarring.
Types of Scars
Scars can be many colours such as pink, red, purple, white, brown, skin-coloured or darker than the skin around it. They can also be itchy, painful or uncomfortable.
| Type | Symptoms |
| Fine-line scar | Can be slightly raised to start, but usually flattens and fades over time without treatment |
| Atrophic scar | Can be a deep, small hole in the skin that looks like a deep pore, or it can be a larger and slightly sunken mark; usually happens after acne or chickenpox |
| Keloid scar | Usually raised, hard and smooth, it grows to be bigger than the original wound, and the area where the scar is may be uncomfortable or difficult to move; it does not usually flatten or fade without treatment |
| Hypertrophic scar | Usually raised and firm, it does not grow to be bigger than the original wound; the area where the scar is may be uncomfortable or difficult to move; it usually fades and flattens over time |
| Contracture scar | Feels tight and the area where the scar is may be difficult or painful to move; it usually happens after a burn |
Source: Scars - NHS (www.nhs.uk)
Assessing a scar and your child needs
There are many different types of scars with different characteristics.
Scar assessment is crucial to meet your child's specific needs and to best improve the scar and overall concerns. Each scar needs to be examined individually to understand the most effective treatment to best improve the look and feel of the scar taking into deep consideration the impact of the scar on your child and his/her overall well-being.
When assessing a scar, we use a team approach and afterwards, we can plan for the best treatment.
How a scar can be assessed
- Clinical judgment: Following a comprehensive consultation including medical background and history of the scar, our team scar will be able to evaluate the quality of the scar.
- Photos: record of photos of scars are an essential way to visually monitor scars
- Cutometer: it is a non-invasive, no painful method to measure the elasticity, firmness, tonicity and suppleness of the skin/scar
- Colorimeter: It is a non- invasive, no painful method to measure the colour of the skin/scar (redness and melanin)
- Ultrasound: It is a non- invasive, no painful method to measure the thickness of the skin/scar
- Scale and quality of life measurements: we use different scales to evaluate the appearance of scars and quality of life. (POSAS, Brisbane, mVSS)
Occupational Therapy Service
“Occupational Therapists help babies, infants, children and young people grow, learn, have fun, socialise and play – so they can develop, thrive and reach their full potential. The focus could be on self-care, like getting ready to go out, eating a meal or using the toilet. It could be around being productive – going to nursery or school, or volunteering. Or it could simply be about improving their ability to play with friends, compete at sport or take part in hobbies.” RCOT, 2024.
Within burn care, Occupational Therapy is an important aspect of treatment and can help to address concerns with function and participation.
Occupational Therapists often use play as a restorative occupation and can provide advice and support to help you return home from hospital, as well as guiding you and the people who can help you go back to school or nursery.
“An ‘occupation’ is any activity that we need, want or like to do.” RCOT, 2024.
Scar Management | Children's Burns Trust
Camouflage Service
Skin camouflage has been used to cover scarring and has been recognised as a treatment technique as far back as the 1920s. Skin camouflage products come in a variety of pre-mixed creams and powders which are used to blend in with the natural skin pigmentation. Skin camouflage products are different from regular beauty products as they are specially formulated to be water-resistant, smudge-proof, durable and high in pigment, allowing for thin, discreet application. This permits the individual to participate in daily undertakings without worrying about it rubbing or washing off whilst doing water/sporting activities.
Using skin cosmetic camouflage products may give a means to restore occupational performance by offering an immediate visual effect therefore reducing anxiety and increasing self-esteem.
The role of the skin camouflage technician is to explain and complete the skin-matching process in order to identify the most suitable colour and product to use and prescribe. Once a match is complete the correct application is then taught.
What is skin camouflage?
It is best described as products (usually a combination of crème and powder) that are high in pigment and are designed to mimic skin colour.
It is waterproof once set and will allow you to take part in social activities including swimming and water sports. It will also stay in place in the bath, shower and rainy weather.
The products will not change the skin texture i.e. the feel or surface of the area to be covered.
What happens in an appointment?
The skin camouflage technician will find a good skin colour match and the product best suited. This involves trying different coloured products on the area of skin that is to be camouflaged. The application and removal technique will be demonstrated in the session. If there are any other skin colour changes e.g. birthmarks, freckles etc, the technician will demonstrate how to apply them for an even match
What happens after an assessment?
After an appropriate colour match has been found, an electronic letter will be sent to their GP, detailing the products that will need to be provided on prescription.
Physiotherapy Service
“Physiotherapists help restore movement and function to as near normal as possible when someone is affected by injury, illness or by developmental or other disability. The range of work is very broad and varied and involves working with people to promote their own health and well being.” (CSP, 2009)
Physiotherapists work with people who have sustained a Burn injury at all stages of their injury from acute management all the way through to discharge and beyond. Our main aims when working with young people who sustain a burn injury are to help them maintain full range of movement at any affected joints and encourage them to mobilise as much as possible aiming to return to preinjury levels of function.
In the initial stages, a full holistic assessment of the patient is carried out to establish safe positioning and initial goals. Respiratory input is provided if clinically indicated along with daily Positioning; need to maintain good position of the head, trunk, arms and legs (crucifix position/getting patient out in chair).
Passive stretching to maintain/improve movement and Patient family education and support. Physios also have a role in the respiratory care of patients especially if a patient has a known inhalation injury, been intubated, had previous respiratory problems or has other respiratory problems as a result of the burn. Therefore the role of the physiotherapist depends on the current stage of the patient in relation to the recovery process (BBA, 2005) along with the needs and desires of the patient.
Inpatient care continues throughout the patients' hospital stay and includes many of the following:
- Goal planning in partnership with patient and family
- Purposeful activity to meet patient’s personal goals
- Continued chest physiotherapy if indicated
- Passive and active stretching
- Active, functional movement
- Create individual exercise programmes if needed
- Mobility and stairs assessment
- Developmental play
- Weekly MDT meetings regarding rehabilitation progress
- Attention to pain and sensitivity
- Liaise with OT’s re: scar management/splinting
- Outpatients: Re-integration stage
- Return to school
- Continued support of the family
- Outpatient rehabilitation bursts of treatment
- Re-assessment of range of movement and mobility
- Developmental assessment
- Liaisons with outside agencies
- Supply/adapt individual exercise programmes
- Longterm follow up
Psychology
The Health in Mind Psychology Service
Birmingham Children’s Hospital has its’ own psychology service, Health in Mind which can support young people under the care of a BCH consultant and their parents or carers. We support when a young person’s psychological difficulties are impacting their physical health, or making treatment difficult. We also support when a young person’s physical health condition is creating psychological difficulties. Please note we are not a crisis service, please see the contacts at the bottom of this page if you are experiencing a mental health crisis.
Psychological Support in Burns
Burns has a Health in Mind psychologist who is part of the Burns team. We know that experiencing a burn injury, either as a young person or as a parent/carer, can be incredibly stressful. Many people recover very well psychologically, however, some people benefit from extra support with their psychological recovery. Research tells us that psychological recovery from a burn can often be the part of the recovery process that is most challenging for families, and we are here to support you with this important aspect of your recovery.
Play Team Service
The play team are here in the hospital to help children deal with the emotions and fears that can occur when a child comes into the hospital setting or has a hospital intervention that can cause upset and anxiety. This could be due to the intervention being painful or scary. One of the main focuses of the play team is to provide stimulating and age-appropriate play for children and young people to help normalise their experiences and create resilience in the child/young person.
Play Specialist
The Play Specialist's role is to help children, young people and the family unit deal with the emotions of getting a burn injury. This support will be offered within the hospital setting in the form of distraction and preparation during dressing changes or further hospital interventions.
They can provide play sessions where the child can explore and gain an understanding of what is about to or has happened to them. Through this discussion questions raised that can be dealt with sensitively and in a way that they can understand. In some cases, support can be offered after the wound is healed. This support can be around dealing with emotions around social interactions, school, dealing with scars etc.
Play Worker
The play worker's role is to provide and facilitate play sessions that the child will find stimulating and enjoyable. These play sessions can be at the bedside or in one of the play areas on the ward.
The play worker will ensure that the play areas are well stocked and have play experiences for children of a range of ages can access freely.
The play worker can provide a basic distraction but can assess this and refer to the play specialist if a more supportive distraction is needed.
Enzo's Friends
This is a support group for children, young people and their families who have sustained a burn injury or who have a condition that causes skin loss. Enzo’s friends help organise activities for the children and their families to attend. At these events, they will have the chance to meet and talk with others who have experienced a similar journey. The play team is involved in this heavily.
Virtual Reality
Virtual Reality (VR) is another tool we can use to promote positive experiences for children and young people at Birmingham Children’s Hospital. The VR headsets immerse patients in digitally created 3D environments, from relaxing beaches to wild safari adventures. Birmingham Children’s Hospital has 25 VR sets, which are medically registered and designed for easy, safe deployment in clinical settings.
Aims of VR:
- Reduce anxieties and fears around procedures and treatment, by encouraging relaxation and distraction.
- S upport reduction or requirement for the use of general anaesthetic or sedation.
- Support basic pain management and help reduce distress for patients.