Objective To analyze the effect of silicone gel treatment on scar thickness and pruritus symptoms in patients with hypertrophic scar after burn. Methods A total of 60 patients with hypertrophic scar after burn admitted to Jingjiang People's Hospital from June 2022 to May 2024 were selected, and they were divided into the control group and the observation group by the random number table method, with 30 patients in each group. The control group was treated with routine scar intervention scheme, and the observation group was treated with silicone gel. The scar thickness, pruritus symptom, treatment effect and complication rate were compared between the two groups. Results After intervention, the scar thickness of the observation group was lower than that of the control group (P <0.05). After intervention, the pruritus symptom score of the observation group was lower than that of the control group (P <0.05). The total effective rate of the observation group (96.67%) was higher than that of the control group (66.67%) (P <0.05). The incidence of complications in the observation group (3.33%) was lower than that in the control group (26.67%) (P <0.05). Conclusion The application of silicone gel in the treatment of hypertrophic scar after burn has a good effect. It can effectively reduce scar thickness, alleviate pruritus symptom, enhance the effect of scar improvement, and has a low incidence of complications after treatment, with high application safety.