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March 22, 2004

Treating Burns
Vol. 16 No. 6 p. 38

A pot of boiling water on the stove, an electrical cord with a kink, a can of lye to drain the sink—all are common household items, and all can cause burns in household accidents.

Burns are common, and many minor burns may be successfully treated with nothing more than self-care. Sometimes, though, burns are more severe and require emergency care or hospitalization. In either case, what you do right away may help determine the severity of the injury and how it’s treated down the road.

A Matter of Degree
Distinguishing a minor burn from a more serious one involves determining the degree of damage to the body tissues. The following classifications will help determine your response:
• First-degree — The skin is usually reddened, and there may be swelling and pain. However, the outer layer of skin (epidermis) hasn’t been burned through. Unless such a burn involves substantial portions of the hands, feet, face, groin, buttocks, or a major joint or you’re having difficulty breathing, it may be treated as a minor burn with self-care remedies. Chemical burns may require different care.
• Second-degree — This refers to burns in which both the epidermis and the second layer of skin (dermis) are burned. Blisters may develop, and the skin takes on an intensely reddened appearance and becomes splotchy. Severe pain and swelling are accompanying symptoms.
If a second-degree burn is limited to an area no larger than 2 inches to 3 inches in diameter, it can be treated in the same way as a first-degree burn. However, if it’s larger, if you’re experiencing difficulty breathing, or if the burn is on the hands, feet, face, groin, buttocks, or over a joint, it’s considered a more substantial burn, warranting emergency medical care.
• Third-degree — This refers to burns that involve both the dermis and epidermis and even the tissue under the skin (subcutaneous tissue). Fat nerves, muscles, and even bones may also be affected. There are usually areas that are charred black or appear as dry white. There may be severe pain or, if nerve damage is substantial, no pain at all. Call for emergency medical care immediately.

Treating Minor Burns at Home
To treat minor burns—first-degree burns and smaller second-degree burns—promptly follow these steps:
• With chemical burns, make sure the chemical and any clothing or jewelry in contact with the chemical are removed.
• Cool the burn under running water long enough to reduce pain—usually about 15 to 20 minutes. If this isn’t possible, immerse the burn in cold water or cover it with cold compresses. Don’t put the ice directly on the burn. Doing so can cause frostbite and further damage.
• Once a first-degree burn is completely cooled, apply lotion or moisturizer to soothe the area and prevent dryness. For sunburn, try 1% hydrocortisone cream or an anesthetic cream. Don’t apply butter to burned skin. It holds heat in the tissues and may cause more damage. It also increases risk of infection.
• Cover the burn with a sterile gauze bandage. Wrap loosely to avoid putting too much pressure on the burn. Bandaging keeps air off the burn and reduces pain.
• Take an over-the-counter pain reliever unless your doctor has told you to avoid these medications. These include drugs such as aspirin, ibuprofen (eg, Advil, Motrin IB), naproxen (eg, Aleve), and acetaminophen (eg, Tylenol).
• Fluid-filled blisters sometimes form. Don’t break the blisters. However, if the area is tender, snip a tiny hole in the blister with a small scissors that has been sterilized in alcohol. If the blister is broken, wash with antibacterial soap and water, apply an antibiotic ointment, and bandage.

After initial treatment, it’s important to keep the burned area well-moisturized by applying a skin lotion. In addition, protect the area from prolonged exposure to ultraviolet (UV) light, such as that given off by the sun, by covering it with clothing or by using a UV-proof sunscreen for at least one year. If there’s scarring, the area may always need sun protection.

If treated properly, first-degree and smaller second-degree burns heal in most people without leaving a scar. Healing can occur in as quickly as one week, although it may take longer if you’re older or have a weakened immune system. The skin may scale or blister, but the pain will likely be significantly reduced within a few days to one week. It may take one month or more for the burned skin to regain its original color.

Treating Serious Burns
Serious burns—second-degree burns with a diameter of 2 inches or larger and all third-degree burns—require emergency medical assistance. Emergency assistance is also required for burns to the airway and for smoke inhalation. Inhaling smoke is one of the life-threatening risks of burns. In addition to calling for help, take the following steps:
• Make sure the cause of the burn has been extinguished or removed. If clothing catches on fire, don’t let the person run—that will only feed the fire. Put out the flames with water, or wrap the person in a blanket or coat and roll him or her on the ground. Ensure that the person isn’t in contact with the smoldering materials, but don’t remove the burnt clothing.
• Be sure the person is breathing. If breathing has stopped or you suspect that his or her airway is blocked, try to clear the airway and, if necessary, do CPR.
• Cover the area of the burn with a dry, sterile bandage, if available, or a clean cloth. A sheet will do if the burned area is large, but don’t use a blanket or towel that may have fibers that can adhere to the burn. Don’t apply any ointments, and don’t break any blisters.

At the hospital, doctors may deliver fluids intravenously, as serious burns can cause significant dehydration. Depending on the severity and size of the burn, you may be referred to a specialty facility that treats burns or to a plastic surgeon. For burns that cover a large area of skin, treatments such as skin grafting may be required to help skin tissue regenerate and aid the healing process.

Serious burns that cover a smaller area may heal without significant medical treatment, although they’re likely to cause permanent scarring. Generally, even serious burns heal much like any other wound—a scab forms over the burned area, skin tissue regenerates, and new, healthy skin grows in the wounded area. It may take four to six weeks or longer for the skin to grow back completely. If the wound becomes infected or you experience dizziness, trouble breathing, or other serious complications, seek urgent medical care.

— Reprinted courtesy of the Mayo Clinic Health Letter

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