The Impact of Dyschromic Burn Scar on Satisfaction with Appearance: A Burn Model System Study

Advances in acute burn care have substantially improved survival, shifting focus towards long-term complications of burn injury that affect quality of life. Hypertrophic scarring is common after burn injury and is often accompanied by dyschromia, a change in scar pigmentation relative to uninjured skin. Despite its visibility, the psychosocial impact of post-burn dyschromia remains poorly characterized. This study examined the relationship between dyschromia, scar thickness, and satisfaction with appearance in burn survivors using longitudinal data from a large, multi-center cohort. Data were obtained from participants enrolled in a national longitudinal burn outcomes database (Burn Model System) with follow-up through 24-months after hospital discharge. Dyschromia and the presence of raised or thick scar were assessed by patient self-report, and satisfaction with appearance was measured using a validated self-report scale. Multivariable logistic regression, survival analyses, and mixed-effects models were used to evaluate cross-sectional and longitudinal associations. Dyschromia was highly prevalent at discharge and strongly associated with raised or thick scar. Female sex and scar thickness were independently associated with reporting dyschromia. Among participants who identified as Black, raised or thick scar predicted both the presence of dyschromia and delayed resolution over time. Persistent dyschromia was associated with sustained dissatisfaction with appearance, while resolution of dyschromia coincided with improvements in satisfaction with appearance. Across models, scar thickness emerged as a consistent determinant of poor psychosocial outcomes. These findings highlight dyschromia as a clinically meaningful sequela of burn injury that is closely linked to fibrotic scar pathology and long-term satisfaction with appearance.