Body appreciation and psychosocial indicators in patients with keloids, hypertrophic scars, and burn scars.

Abstract

Introduction: Scars present repercussions beyond physical appearance, affecting emotional well-being and social interactions. Few studies have compared how different scar types, including keloids (K), hypertrophic scars (HS), and post-burn scars (BS), relate to psychosocial outcomes.

Objective: Assess body appreciation and screening indicators of anxiety and depression in patients with scars of different etiologies.

Methods: We conducted an exploratory cross-sectional study including 42 patients with scars allocated to three groups: K, HS, and BS. Body image perception was measured using the Body Appreciation Scale (BAS), and anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). Mean BAS and HADS scores were compared across groups, and associations with clinical features were explored.

Results: The combined prevalence of anxiety and depression symptoms increased descriptively from HS (0%) to K (5.9%) to BS (20%) (p = 0.11). Higher odds of combined anxiety and depression symptoms were associated with facial involvement (p = 0.017; OR = 19.8, 95% CI 1.70-229.65), and functional impairment (p = 0.039; OR = 18.0, 95% CI 1.59-202.95) features more frequent among burn patients, although confidence intervals were wide. BAS scores did not differ significantly among groups (p = 0.78), indicating moderate-to-high body appreciation across scar types (mean BAS: 3.68 burns, 3.77 hypertrophic, 3.85 keloids). Anxiety (p = 0.57) and depression (p = 0.43) scores were similar.

Conclusion: Different scar types were associated with broadly similar psychosocial outcomes. Emotional vulnerability among patients with burn scars appears more closely related to scar-related features, such as facial location and functional impairment, than to scar etiology alone. Findings should be interpreted cautiously and regarded as hypothesis-generating.

Lay summary: This study examined how different types of scars, including burns, hypertrophic scars, and keloids, may affect emotional well-being and body image. Adults with these scars completed questionnaires assessing body appreciation, anxiety, and depression. Overall, levels of body appreciation were similar across groups, suggesting that many people can adapt to visible or symptomatic scars over time.Participants with burn scars showed a tendency toward higher levels of anxiety and depressive symptoms. However, these emotional difficulties were more strongly associated with features such as facial involvement and functional limitations than with the type of scar itself. This highlights the importance of considering the broader clinical and social context in which scars occur.As this was an initial study with a relatively small number of participants, the findings should be interpreted as exploratory rather than definitive conclusions. Overall, the results suggest that while many people adapt well to scars, those accompanied by greater visibility or functional impact may be linked to emotional vulnerability. Comprehensive scar management should therefore address not only physical and psychological support but also promote recovery that considers the person as a whole.