[Yonsei Star Dermatology Sinchon] Hyperpigmentation and Hypopigmentation in Burn Scars: Causes and Care Methods

Burn scar pigmentation refers to a condition where brown or white, uneven blotches remain on the skin even after a burn has somewhat healed. The first question we hear in the consultation room is often similar: "My wound has healed, but why is the color still there?"

When skin is damaged, the cells that produce melanin pigment can become overactive during the healing process. This is called post-inflammatory hyperpigmentation, and burns are known to cause a relatively strong reaction of this type. Knowing in advance that color changes may persist for some time even after the wound surface closes can bring a sense of ease.

Even with the same burn, the degree of pigmentation varies greatly from person to person. Generally, pigmentation tends to be more prominent when the following factors overlap:

• Damage extending to the dermal layer. If not only the epidermis but also dermal pigment cells and surrounding tissues are damaged, the regulatory function for pigment production can become unstable.
• Repeated inflammation during the healing process. If irritation and inflammation recur while the wound is healing, pigmentation can become deeper and more widespread.
• Exposure to UV rays during treatment and dressing. Healing skin is sensitive to UV rays, and even brief exposure can lead to a strong pigment reaction.
• Inherently sensitive skin characteristics. Individuals with darker skin tones or a sensitive pigment response tend to develop darker pigmentation.

Pigmentation that has progressed to burn scars typically requires a longer recovery time than simple bruises or light abrasions. Without proper management, it may persist for a long time.

The reason burn scar pigmentation often appears particularly uneven is that different skin tones are mixed within one area. Since the depth of damage and healing speed vary from area to area, both darkened and lightened spots can appear simultaneously.

These two conditions appearing together within one scar create an overall mottled impression. Which one is more prominent depends on the extent of damage and healing patterns, so there is significant individual variation.

• The skin tone is uneven. Dark brown, reddish, and lightened white areas are mixed depending on the depth of damage and healing speed.
• Hyperpigmentation and hypopigmentation coexist. Areas with excessive pigment and areas with reduced pigment coexist, leading to an uneven tone.
• Weak to UV rays. Healing skin has reduced UV defense, so even brief exposure can cause pigmentation to darken or spread.
• Natural recovery is slow. If the damage is deep and extensive, natural recovery alone may take a long time or may not fully restore the skin.

If the color does not fade and remains a concern for a long time, it is advisable to have your skin condition checked rather than making a judgment on your own.

Laser procedures are sometimes used for burn scar pigmentation. However, unlike general pigmentation, burn scars involve altered skin structure, so a thorough diagnosis of the skin condition and determining the appropriate approach is crucial. Even with the same equipment, the output and interval are carefully adjusted according to the scar condition.

• Lasers targeting pigment. Short pulses break down melanin particles in hyperpigmented areas to induce natural excretion. Since the scar area may have unstable skin conditions, output and treatment intervals are handled carefully.
• Lasers inducing surface regeneration. When scar tissue and pigment remain together, these lasers are used to aid skin surface regeneration and improve the resulting skin tone.
• Lasers addressing redness. If erythema persists for a long time, lasers targeting blood vessels may be used to alleviate it. If redness and brown pigmentation are mixed, different methods may be used in stages.

If epidermal pigmentation is the primary concern, Epidermal Pigment Removal or Customized Whitening Solution may be helpful. RePott Laser is also a method used for tone correction. The appropriate approach will be determined after examining both the scar and pigment condition.

Consistent home care alongside hospital treatment can help create a favorable healing environment. We recommend incorporating these simple steps into your daily routine:

• Apply sunscreen daily. Burn scar areas are particularly vulnerable to UV rays. Apply SPF50 PA+++ or higher, indoors and outdoors, and reapply every two to three hours.
• Use physical barriers outdoors. Utilizing UV-protective clothing, hats, and parasols can help reduce exposure.
• Moisturize sufficiently. Post-burn skin has reduced moisture retention and is sensitive to irritation. Apply a low-irritant moisturizer generously at least twice a day to protect the skin barrier.
• Apply when skin is damp. Applying moisturizer immediately after washing or bathing, while the skin is still damp, helps with absorption.
• Avoid scratching or irritating the scar. Forcibly removing scabs or rubbing the area can lead to more pigmentation, so avoid these actions.

Pigmentation varies slightly depending on the type of scar. Scars and pigmentation can result from various causes other than burns, so checking information relevant to your condition can make consultations much smoother. You can also review general characteristics of Burn Scar, as well as the progress of Surgical Scar and Cosmetic Surgery Scar. If redness along with the scar is a concern, information on Facial Redness may also be helpful.

Does pigmentation disappear on its own over time? If the damage is shallow, it may fade over time, but for deep and extensive damage like burn scars, natural recovery alone may take a long time or may not fully restore the skin. If changes are slow, it is advisable to have your condition checked.

How much improvement can be expected once treatment begins? The degree and speed of recovery vary greatly depending on the depth of damage, skin characteristics, and care habits. Rather than promising a fixed outcome, it is a process of setting a direction tailored to your condition.

If burn scar pigmentation is a concern, we recommend having your skin condition directly assessed rather than worrying alone.

Chief Director Lee Sang-joo (MD, PhD, Yonsei University College of Medicine and Graduate School, completed dermatology residency at Severance Hospital, President of the Korean Dermatological Association) Chief Director Lee Sang-joo's Profile First Published 2026-05-29 / Last Reviewed 2026-06-16

This content provides general information for understanding, and since healing patterns vary from person to person even with the same burn scar, the actual treatment direction should be determined through individual consultation during a medical examination.