Minor Burns

Minor Burns

Most of us have suffered minor burns at one time or another. The term “burn” is actually broader than many people realize, however. Most people believe heat causes burns, and of course it can, but the medical definition of a burn has more to do with the type and depth of damage to the skin, not the source of the damage. Burns can be thermal (from extreme heat or cold), chemical (such as from acid) or radiant (such as from sunburn, x-rays or artificial ultraviolet rays from a tanning booth). All cause skin damage and you should treat them similarly.

Classifying Burns

The old "first, second and third degree" system for classifying burns is still common with the public, but doctors now use the terms partial thickness and full thickness to describe burn injuries. Partial thickness burns don’t extend completely through the dermis; full thickness burns do (see diagram to compare classifications). The chart below helps to differentiate burn types. As you can see, partial thickness burns (first degree and second degree) usually heal well and are easier to care for. This is because new skin can grow upward from the dermis; if the dermis is destroyed (full thickness or third degree burn), no skin can grow back in that area and deep scarring develops unless skin grafting is performed.

For the classic sun burn (first degree burn) with redness, slight swelling, and mild pain, home treatment is safe and works well for up to 50% of the body surface. Blistering burns (second degree) can be self-treated in many cases, but should be seen by a physician if:

More than 1% of your skin surface is involved (more than the size of the patient’s palm).
Face, neck, genital area, hands, or feet are involved.
Any child under 12 years of age should be seen by a physician for blistering burns.

You should never self-treat a full thickness burn, no matter how small. The risk of infection and significant scarring is just too high. In the event of a full thickness burn, go to the nearest emergency room right away or call 911.

Special Burns

Any electrical, steam or inhalation burn (such as smoke, chemical, extremely hot air or vapors) must be evaluated by a physician right away. These types of burns can have unusual complications despite mild symptoms at first and are too complex for self-treatment. In the event of these types of burns, go directly to the nearest emergency room or call 911.

Since nearly all burns are accidental, prevention is mostly a matter of basic safety, such as avoiding extreme heat, caustic chemicals, etc. But there is one type of burn that people practically seek out: sunburn. Because it isn’t immediately painful, is associated with fun activities and results in a pleasant skin tone if you don’t go too far, many people are willing to risk a little first degree burning.

That’s a big mistake. Both natural and artificial ultraviolet rays are extremely damaging to the skin. Everyone knows about premature skin aging and increased cancer risks, but you may not know that second degree burns with blistering and sometimes infection and scarring are very common with sunburn. Children especially must be protected from exposure. A simple application of level 30 sun block will prevent all of these problems.

There are literally dozens of medications (available both by prescription and over the counter) which make your skin more sensitive to the sun. Second degree burns can result with only brief exposure when your skin is sensitized by these drugs. Be sure to check with your doctor or pharmacist if you plan to be in the sun and are taking any medications.

The most immediate treatment for both thermal and chemical burns is to stop the burn from progressing. Clothing saturated with caustic chemicals or hot substances should be removed immediately and the affected skin area placed in cold water (but not ice water, and do not apply ice to the burn). If done within the first minute or so, immersion in cold water for up to 30 minutes can reduce both the total area involved and the depth of the burn.

After these immediate measures, there are two treatment goals: relief of pain, and healing without scarring or infection. For first degree burns, you can easily achieve these goals with over the counter pain relievers and a moisturizer to protect the skin for a few days. This prevents the delicate new skin underneath the burn from drying out, cracking, and peeling away with the burned skin layers on top of it. Topical anesthetics can help too (see Recommended Products section).

Deeper burns require much more treatment. Below is a standard burn dressing and treatment protocol for blistering second degree burns. See a doctor if you are not sure about the best way to treat any burn.

Make sure the area of all blistering burns is less than the size of your palm. If larger, see a doctor.

If the blister is intact, leave it alone! The skin underneath the blister is actually healing while the blister protects it from further damage and infection. Use sterile white petrolatum or petroleum jelly and a light gauze wrap to protect it until it bursts on its own (this can take days). Do not apply butter to the burn in place of petroleum jelly; that can lead to infection.

Once burst, remove the collapsed skin from the blister with gentle washing and sterile tweezers.

The raw, weeping skin under the blister must be protected after the blister bursts. Use Adaptic (Petrolatum gauze) for the non-stick first layer. Place dry gauze as a second layer to absorb moisture oozing from the raw surface beneath the first layer. This prevents breakdown of the skin from sogginess. Rolled gauze wrap is the final layer holding the others in place and limiting movement.

Change this dressing once or twice daily and wash gently with an anti-bacterial soap. This stops an unwanted thick membrane from forming on the raw burn surface and prevents infection.

Depending upon the size and depth of injury, you may need to continue the above process for one to three weeks. When the new skin beneath the dressings is dry (but not crusty or scabbed) and no longer stings to touch, you can stop the dressings. The new skin is pink, thin, and delicate. You may choose to protect it for another week with a single layer of gauze wrap until it is sturdier.

Anti-inflammatory medication helps control pain, swelling, and redness. They should be taken around the clock, with longer acting brands preferable since awakening in the middle of the night with burn pain is common with shorter acting medicine.

Adaptic (non-stick wound dressing). This type of dressing has several advantages when treating second degree burns, including easier and less painful dressing changes, much quicker healing and preventing maceration (break down of skin due to excessive moisture).

Aleve (naproxen sodium 220 mg). This quick acting anti-inflammatory gives eight to 12 hours of pain relief (longer than other over the counter anti-inflammatories). Because inflammation is a main factor in burn pain, Aleve can be more effective than acetaminophen products such as Tylenol. This longer acting anti-inflammatory works well when used in conjunction with faster topical anesthetics such as Dermoplast.

Mycitracin (polymyxin B 10,000 IU/g, bacitracin zinc 500 IU/g, neomycin sulfate 5 mg/g). Prevention of infection in second degree burns is important and there is no stronger over the counter antibiotic than this product. Applied two or three times a day, it is very helpful in combination with good wound care for preventing infectious complications of burns.

Dermoplast spray (benzocaine 20%, menthol .5%). For the pain of first degree burns (as opposed to the raw open wounds of second degree burns), this product can provide instant but temporary relief from the surface burning sensation. Quick acting surface anesthetics like these work well in combination with longer acting, but slower onset, anti-inflammatories such as Aleve.

See the precautionary recommendations under the Basics section. In addition to these situations, if you notice any signs of infection, a physician should be consulted promptly. Many people worry needlessly about a yellowish or light green slime that covers raw second degree burns. This is part of the body’s normal response to a burn. The green/yellow color does not necessarily mean infection. Redness, swelling, pain and fever are much more reliable indicators of infection. You should be especially concerned about infection if redness starts to spread or enlarge in the days following the burn; normally, redness should shrink as the burn heals.

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