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Managing minor burns - General recommendations for home management

Pain, Skin Conditions, General | September 22, 2015 | Author: The Super Pharmacist

Skin conditions, general, Pain

Managing minor burns - General recommendations for home management

Virtually all minor burns can be successfully treated at home, i.e. without seeking medical attention.1,2 Unfortunately, more severe burns require prompt medical attention. Therefore, it is critical to correctly distinguish between minor burns and burns that are more severe.

How do you know you have a minor burn…or something worse?

Burns are classified based on the thickness of the burn (depth) and the amount of skin or tissue that has been burned. 

Partial-thickness vs. full-thickness burns

People are usually more familiar with the terms first-degree, second-degree, and third-degree burns. If first-degree burn is one in which no blistering occurs. The second-degree burn is associated with blistering. In third-degree burns the entire depth of skin has been destroyed by the burn. Unfortunately, partial and full-thickness burns do not fit nicely within these categories. A first-degree burn is always a partial-thickness burn while a third-degree burn is always a full-thickness burn. Unfortunately, second-degree burns can be either partial or full-thickness burns.3 Second-degree burns are divided into partial-thickness and full-thickness burns. A partial-thickness, second-degree burn will form blisters between the dermis and epidermis within 24 hours of the burn. These burns are painful, red, produce clear fluid, and will turn white when pressed (as the blood pushes out of the capillaries). Full-thickness, second-degree burns will cause damage to hair follicles and glands. They are painful only when pressed, which causes the skin to blister and possibly slough off. Pressing on them does not cause them to turn white like partial-thickness second-degree burns do. To be on the safe side, if you think you might be dealing with a full-thickness burn, you should have it evaluated by a physician. Likewise, large minor burns may cause significant pain that cannot be controlled by over-the-counter analgesics (painkillers). Therefore, a physician may prescribe painkilling medications to help control the pain while the burn heals.

Calculating body surface areaManaging minor burns - General recommendations for home management

Physicians use a rather simple tool to calculate the amount of body surface area affected by burn. It is called the rule of nines, and it is surprisingly accurate.4 With the exception of the genitals, each major portion of the body represents 9% of the body surface area. The 11 portions of the body each representing 9% are the:

  1. Head
  2. Chest
  3. Abdomen
  4. Upper back
  5. Lower back
  6. Right arm
  7. Left arm
  8. Front of right leg
  9. Back of right leg
  10. Front of left leg
  11. Back of left leg

The importance of distinguishing minor burns from more severe burns

There are at least two important reasons that it is essential to distinguish between minor burns and more severe burns. Full-thickness burns damage the skin's ability to heal without scarring. Therefore, full-thickness burns often require advanced treatments such as skin grafting to avoid ongoing cosmetic defects. Full-thickness burns also interfere with the skin's ability to protect against infection. Thus, serious infection is a real risk with more serious burns. Indeed, antibiotics (intravenous, oral, and topical) may be needed to prevent serious and/or life-threatening infection.

OK, you are confident you have a minor burn, now what?

The first step in minor burn management is to cool the burn. Remove any clothing near the burn and apply room temperature or cool tap water to burn. This may temporarily relieve some acute pain and may stop ongoing burning. It is not a good idea to apply ice or ice water to a burn, however.5,6

The second step in minor burn management is to clean the wound. Not so long ago, many people believe that using isopropyl alcohol, hydrogen peroxide, or iodine was a useful way to clean burns. Applying antiseptics is no longer accepted by the medical community7 and, in fact, should be avoided. Instead, use a mild household soap and tap water to gently clean the wound.

The third step in minor burn management is wound debridement. Debridement is simply the act of removing dead skin from the wound, including ruptured blisters. Clean, intact blisters, on the other hand, should be left intact.8

The fourth step in minor burn management is to coat the wound. Any burn with an intact epidermis (top layers of skin) does not require topical antibiotics because they typically do not develop infections.9 Superficial burns (formerly called first-degree burns) can simply be coated with aloe vera gel, which has the benefit of cooling and moisturising the area. If the epidermis has been disturbed, a topical antibiotic cream or ointment should be applied. Interestingly, the application of honey to a wound appears to effectively halt bacterial growth and help promote wound healing.10,11 Managing minor burns - General recommendations for home management

The fifth step in minor burn management is to consider wound dressings. Superficial burns (i.e., first-degree burns) do not require dressings. Assuming that the burned person does not need to be evaluated by a physician, the basic dressing for at-home treatment of minor burns consists of three layers. After applying a topical antibiotic, the wound should be dressed with a layer of non-adherent gauze, also called nonstick gauze pads. This layer is important so that the dressing does not stick to the wound during dressing changes. The second dressing layer should be dry, fluffy gauze followed by a sturdier (normally adhesive) third layer to hold the dressing in place.

The sixth step in minor burn management is pain control. Fortunately, the pain caused by most minor burns can be controlled by over-the-counter analgesics such as paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen. These medicines should be taken throughout the day as indicated in the directions for that medication to effectively manage pain and inflammation. This differs from how one would take over-the-counter pain medicine for aches and pains are a headache. The idea is to prevent pain from occurring rather than stopping the pain once it starts. Additional pain medication may be needed for "breakthrough" pain. The final step in minor burn management is routine dressing changes. There is no set rule on how often dressings should be changed for minor burns. One possible recommendation for burns that require  topical antibiotics with non-adherent gauze is to change dressings once or twice daily.12 Fresh antibiotics and gauze should be used during each dressing change.

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REFERENCES:

  1. Brigham PA, McLoughlin E. Burn incidence and medical care use in the United States: estimates, trends, and data sources. J Burn Care Rehabil. Mar-Apr 1996;17(2):95-107.
  2. Gabbe BJ, Watterson DM, Singer Y, Darton A. Outpatient presentations to burn centers: data from the Burns Registry of Australia and New Zealand outpatient pilot project. Burns. May 2015;41(3):446-453. doi:10.1016/j.burns.2014.11.013
  3. Mertens DM, Jenkins ME, Warden GD. Outpatient burn management. Nurs Clin North Am. Jun 1997;32(2):343-364.
  4. KNAYSI GA, CRIKELAIR GF, COSMAN B. THE RULE OF NINES: ITS HISTORY AND ACCURACY. Plastic and Reconstructive Surgery. 1968;41(6):560-563.
  5. Pushkar NS, Sandorminsky BP. Cold treatment of burns. Burns Incl Therm Inj. Nov 1982;9(2):101-110.
  6. Clayton MC, Solem LD. No ice, no butter. Advice on management of burns for primary care physicians. Postgrad Med. May 1995;97(5):151-155, 159-160, 165.
  7. Hill MG, Bowen CC. The treatment of minor burns in rural Alabama emergency departments. J Emerg Nurs. Dec 1996;22(6):570-576; quiz 576-578.
  8. Rockwell WB, Ehrlich HP. Should burn blister fluid be evacuated? J Burn Care Rehabil. Jan-Feb 1990;11(1):93-95.
  9. Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, Kongkaew C. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns. Sep 2007;33(6):713-718. doi:10.1016/j.burns.2006.10.384
  10. Jull AB, Rodgers A, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2008(4):CD005083. doi:10.1002/14651858.CD005083.pub2
  11. Wijesinghe M, Weatherall M, Perrin K, Beasley R. Honey in the treatment of burns: a systematic review and meta-analysis of its efficacy. N Z Med J. May 22 2009;122(1295):47-60.
  12. Baxter CR. Management of burn wounds. Dermatol Clin. Oct 1993;11(4):709-714.
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