Originally published in The Ottawa Citizen February 12, 2004
Original Title: A Burning Issue

Many people are unaware of the proper management of burns. Is there a need to apply creams, antibiotics, salves or natural products to promote healing? What are the first steps to prevent or minimize skin damage in the immediate aftermath of a burn?

An understanding of burns begins with a review of the four layers of the skin: the epidermis, dermis, subcutaneous (tissue under the dermis), and muscle.

The epidermis is the tough skin surface and our protective barrier against disease and the elements. The dermis resides under the epidermis and holds the small arteries, veins, sweat glands and hair follicles. The subcutaneous layer contains fat and more blood vessels. The muscle is the deepest layer.

Immediate treatment of mild to moderate burns is vital to lessen the damage. The treatment of severe burns is beyond the scope of this column.

Burn severity and its potential complications relies on the depth of skin damage, the percentage of burned body surface area, the burn mechanism (e.g. hot sticky tar versus a flash flame) and the area affected (face, hands, eyes, genitals, etc). In addition to fire and heat, radiation, electricity, chemicals and sunlight are other causes of burns.

Thin or superficial burns (first-degree burns) are red and painful. The skin may be slightly swollen and turns white (blanches) if you press on it. Damage is limited to the epidermal layer and the skin may peel away a few days after the burn. It usually heals within three to six days.

Second-degree burns cause blisters and are painful. There are two subcategories: superficial partial-thickness and deep partial-thickness burns. Superficial partial-thickness burns extend into the dermis. These blistering wet-looking wounds will seep fluid and blanch with pressure. They heal within three weeks.

Deep partial-thickness burns will extend into the subcutaneous fatty layer. These burns have a waxy appearance and do not blanch with pressure. Blisters will easily rupture if touched. Healing time is greater than three weeks.

Full-thickness third-degree burns cause damage to all the layers of the skin. The burned skin looks waxy white, charred or leathery gray in color. These burns may cause little or no pain if the nerves are damaged. These burns will only heal at the skin edges and form scars unless skin grafting is done.

Each of these burns requires specific treatment. Never apply butter, oil, ice or ice water on burns because it can cause more damage. It is best not to apply any lotions or creams until a burn-type diagnosis is made.

Superficial burns require immediate soaking in cool water (50 degrees to 55 degreesF or 10 degrees to 13 degreesC) for at least 10 to 15 minutes. The cool water will prevent some of the burned tissue from dying and help ease the pain. Although application of antibiotic creams and salves like aloe vera will not speed healing, they may provide some wound comfort. Use a dry gauze bandage to cover the burn if it needs protection. Acetaminophen or ibuprofen can help control the pain.

Superficial partial-thickness or deep partial-thickness burns should soak in cool water for 15 to 20 minutes. If the burn is small, apply a cool wet clean cloth to it for a few minutes each day. Thereafter, apply the antibiotic cream or ointment prescribed by your doctor. Wash your hands with soap and water and/or use an alcohol gel disinfectant before any dressing change.

Cover the burn with a nonstick bandage like Telfa and hold it in place with gauze or tape. Never use mesh gauze to cover the wound because it will incorporate itself into the tissue and is very painful and damaging when removed. Make sure you are up-to-date on tetanus shots. Stronger prescription pain-relieving medication is available.

Do not break any blisters because this can lead to infection. Your doctor may have to drain the blisters that cover joint areas because they may restrict movement.

Infected burns usually become increasingly red, swollen and painful and form pus. Look for these signs when doing a daily dressing change and consult your doctor should this occur.

Ensure your fingernails are cut short because burns itch as they heal. The damaged skin is sensitive to sunlight for up to a year after the injury. Exposure to sunlight can cause a permanent dark tanned patch.

If any of these burns covers an area greater than 10 per cent of the total body surface or is on the face, hands, feet or genitals, see a doctor immediately.

Full-thickness burns require immediate hospitalization. Do not remove any clothing stuck to the burn and do not soak the burn in water. Remove loose clothing and jewelry.

Electrical burns may not show any skin damage but often cause serious internal injuries. Chemical burns should be washed with copious amounts of water. Remove any chemical-soaked clothing. Do not apply anything to the burn because of the risk of a chemical reaction. Both chemical and electrical burns require an emergency room evaluation.

Prompt treatment of burns can help reduce the extent of scarring and infection.

For more information, check the website http://www.findarticles.com/cf_dls/m3225/9_62/67051929/p1/article.jh tml

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© Dr. Barry Dworkin 2004