Ask the Experts: Opening Wounds

Ask the Experts...

Dear Burn Community, 

Welcome to "Ask the Experts," Journey Magazine's advice column. In this edition, we received common questions that we often hear from our community about facing fears after a burn injury, how to treat wounds that keep reopening, and handling Halloween. As we respond to your questions, we draw on our personal and professional experience to offer guidance. Our goal is to provide valuable advice and support to the burn community.

Have a question? Whether you are a burn survivor, caregiver, or community ally, we want to know what's on your mind. Submit your questions to resources@phoenix-society.org with the subject line "Ask the Experts."

Sincerely,

Sam, Felicia, Lise

Question: Opening Wounds

Dear Experts,

Is it common for scars to get softer, burst, heal, and then repeat the cycle again? I’m noticing this happens for a thick scar on my son's back. At first, I thought it was maybe a good thing it bursts as there is a possibility of flattening the scar in this process. But it has happened a few times, and it's been two years since injury.

Gayathri

RESPONSE FROM Felicia N. Williams, MD, FACS

Dear Gayathri,

This is a great question! Burns are more of a chronic issue than just an acute one.

First, let me preface my answer: everyone heals, scars, and reacts differently. We know it’s common for people to experience delayed blisters over previously healed burns and donor sites. These blisters form but heal within days. This happens most commonly weeks to months after injuries but has been seen for years after injury. It has been associated with trauma to these areas, infection, or can be spontaneous. It has been suggested that this is secondary to the fragile nature of this healed skin. Specifically, the junctions between the layers of the “new skin” are weaker compared to the way they used to be, leading to increased blister formation. This has also been associated with areas of hypertrophic scar formation. The “thick scar” you mentioned on your son’s back may be a hypertrophic scar.

As far as how long this may occur—it has been reported by survivors that the incidence of raised or hypertrophic scars decreased after five years and that the fragile nature of their new skin also decreased over time, but about one-fifth of those asked, decades after injury, reported still having fragile skin.

Since the etiology of the delayed blistering can be multi-factorial, I recommend re-engaging your burn team to help manage changes in the skin over time and expectations for how things will heal. This will optimize the chances your son will live his best life.

Dr. Felicia Williams is a Burn Surgeon at University of North Carolina - Chapel Hill. She is an Assistant Professor in the Department of Surgery and is the Associate Division Chief for the Burn Division. She completed her General Surgery Residency at ECU and her training in Galveston under Dr. Herndon, dedicating her life to burns. She has many publications, with a current research focus on health disparities in burn care. Felicia also serves on the Phoenix Society for Burn Survivor’s Board of Directors.

Disclaimer: The medical information provided on this website is intended for general informational purposes only and should not be considered a substitute for professional medical advice, diagnosis, or treatment. Medical knowledge is continually evolving, and recommendations may change over time. Content shared by subject matter experts reflects their expertise and experience at the time of publication and may not be applicable to all individuals. Always seek the guidance of your physician or another qualified healthcare provider with any questions you may have about a medical condition. The views expressed by individual contributors do not necessarily reflect those of Phoenix Society for Burn Survivors.