Pressure Therapy

Why Pressure Therapy?

Pressure therapy is a standard treatment to prevent hypertrophic scars (mainly burn scars). Pressure therapy involves wearing garments made from elasticized fabrics or wearing masks/collars made from hard materials maybe with a silicone top layer. The exact reason why pressure works is still not fully understood. It’s thought that pressure controls collagen synthesis and limits the supply of blood, oxygen and nutrients to the scar tissue. It may also have a role in reducing inflammation.

Whole body treatment?

Applying pressure evenly across the body is very challenging. Pressure garments are not ideal for the face/head and concave areas. Pressure is best suited for hypertrophic scars on the limbs. Pressure to the face and other more difficult to reach areas can be easier with rigid transparent materials with silicone linings. Sometimes polyurethane inserts are used to increase the pressure in concave areas. Pressure therapy is particularly effective in the prevention and treatment of raised hypertrophic scars.

Pressure therapy normally should be worn for 23 hours a day (removed for washing, dressing and some treatments); often pressure is applied for 6-12 months or until the scar is matured. The garments are individually measured and fitted to the patient by a skilled technician. For best results, pressure garments should be replaced every two to three months. The amount of pressure often used in scar management is 15-25mmHg. Pressure higher than 40mmHg may cause severe discomfort and could be harmful.

Main improvements

Reduced scar redness
Reduced scar height and thickness
Improved pliability

Adverse effects

Possible adverse effects:

Itching and heat sensations (due to prolonged wear)
Blistering (too much pressure or friction)
Ulcerations (too much pressure or friction)
Scar/wound breakdown (too much pressure or friction)
Limb swelling (too much pressure)

Recommendations

Used as a prevention measure when wounds take longer than 21 days to heal and for skin grafts i.e., for all wounds where scarring is expected.
Use as soon as the skin is healed and can tolerate the pressure and/or shear force generated by a garment.

Photo of pressure garments on hand and arm

Photo of pressure garment for hand and wrist

Photo of pressure garments on hand, arm and upper body

Photo of somebody taking a pressure garment off the hand and wrist

Photo of pressure garment at the shoulder

Used for

Table: When to use pressure therapy

Desired Outcome	Strongly recommended	Recommended	Insufficient evidence and lack of consensus	Not recommended
Decreased height	x
Decreased erythema		x
Increased pliability			x
Increased range of motion			x
Decreased pigmentation				x
Decreased time to maturation				x

F.A.Q.

For which types of scars is pressure therapy suitable?

Pressure therapy is suitable for thick scars, primarily caused by burns, and is effective for hypertrophic scars on the arms, legs, and torso. It is less suitable for the face and other hard-to-reach areas such as concave body parts.

How long should pressure therapy be applied to see results?

The duration of pressure therapy for scars can vary depending on the type of scar. For hypertrophic scars, pressure therapy is typically applied for 6-12 months. For burn scars, pressure therapy can be used for 6 months to 2 years, depending on the severity and extent of the scars. The garments should generally be worn for 23 hours a day, only being removed for washing, dressing, and some treatments.

Is pressure therapy suitable for older scars or does it only work on new scars?

Pressure therapy can be applied to both new and older scars, but it is generally more effective on newly formed scars. It can still produce beneficial results for older scars, although the degree of improvement may be less pronounced.