Burns

LifeSource Vitamins

Burns have a number of causes, including thermal agents, ultraviolet light radiation, chemicals, and electricity. Burn damage in the skin causes cellular death, capillary injury, and coagulation of protein. Capillary injury is manifested by increased capillary permeability, resulting in a wet or weepy appearance of second and third degree burns.

About two million burns occur yearly in the United States. On average 500,000 are seen in the emergency room. 100,000 result in hospitalization, and 20,000 are of sufficient severity to necessitate care in a burn center. Burns are the fourth most frequent cause of death from unintentional injury. Over 80% of minor burns occur in the home, usually being caused by scalds, contact burns, and fabric burns. Most of these burns do not require medical assistance, and may be managed by the patient with appropriate care and nonprescription products.

Of the minor burns that occur outside the home, sunburn is the most common. Sunburn has been underrated in most burn surveys because the public does not consider sunburn in the same context as thermal burns. Sunburn is different from thermal burns in that it does not result from an abrupt temperature increase in tissue, but rather is produced gradually from the ionizing radiation of the sun or other ultraviolet light source. It is also the only burn that is considered preventable and generally results from a willful choice of prolonged exposure to sunlight.

Thermal burns can be caused by flames, flaming liquids such as food or drinks made with high-proof alcohol and set afire, hot liquids such as water or oil, hot objects such as curling irons, burners, irons, and even hot pavement, and hot gasses such as steam burns, or gasses released during airbag deployment. Scalds represent about 30% of burn injuries and generally occur from common household accidents. Sources include boiling water, hot coffee, soup, or other hot beverages, and even hot water from a faucet. Because a child's skin is much thinner than an adult's, it is easy to cause scalding even in hot tub water. For this reason, it is recommended that all hot water heaters be adjusted to no more than 120-130 degrees F.

Chemical burns result from exposure to caustic chemicals such as acids and alkalis. Battery acid, hydrochloric acid, and sulfuric acid are a few examples, as well as drain cleaners, caustic lime, oven cleaners, and cement. Chemical burns can also result from garlic applied to the skin as a natural remedy.

Electrical burns usually result from touching the source of electricity. In the pediatric population, this can occur when children bite through cords or place objects into outlets. In evaluating electrical burns, both the entrance and exit site must be evaluated. Electrical burns are usually considered quite serious, and depending upon the voltage exposure, may cause full thickness injuries affecting muscle and even bone.

Symptoms

Burn symptoms vary, depending on burn severity. In appearance, burns range from the red of sunburn to the charred appearance of a fourth degree burn. Superficial burns are very painful due to tissue damage, however, deep burns are much less painful because nerve destruction has occurred. While superficial burns appear red, and slightly more severe burns develop blisters, very severe burns eliminate the layers of skin that cause blistering.

As a minor burn wound heals, severe itching may develop. Signs of infection include erythema, edema in the tissue surrounding the burn, increasing pain, odor, drainage, necrosis or darkening tissue color.

The classic method of categorizing burns is by degrees.

First Degree

Affects epidermis and hair

Localized edema

Redness

Pain

Blanch when pressure is applied, quick refill

Healing generally occurs within 3-5 days

No associated scarring

Peeling may occur

Itching while healing

Second Degree

Affects epidermis, dermis sebaceous glands, sweat glands, and hair follicles

Redness

Pain

Blisters

Loss of proteinaceous fluid

Blanch when pressure is applied, refill slowly

Mild forms heal in 7-10 days, more severe burns may take up to 8-12

Third Degree

Affects the epidermis, dermis, subcutaneous layer and associated structures

Leathery, dry, inelastic or charred appearance

Little or no pain

Healing is a lengthy process

Scarring

Danger of secondary infection

Grafting may be necessary

Fourth Degree

Affects epidermis, dermis, subcutaneous layers, muscle and possibly bone

Charred appearance

Generally not painful

Danger of deep infection

Loss of circulation to affected area

Grafting necessary

Severe scarring

Treatment

Treatment approaches depend upon the extent and severity of the burn. Only first degree and minor second degree burns are considered self-treatable. Also to be considered is the source of the burn, with sunburn and thermal burns being self-treatable, while chemical and electrical burns should be referred to a hospital for treatment.

Immediate treatment from minor thermal burns consists of prompt cold applications (ice water) that are continued until pain does not return upon stopping them. Heat destroys tissues through denaturation of native protein and disruption of cell membranes. However, protein that has undergone heat-induced denaturation can refold into its original configuration if cooled rapidly enough. If no effort is made to cool the tissues, the elevated temperature may continue to produce injury for several minutes.

For mild (first degree) burns, topical corticosteroids and oral analgesics or NSAIDs can be helpful. Small second degree burns may be treated with a topical anti-infective ointment to minimize bacterial growth and to keep the lesion moist while healing occurs. Topical local anesthetics, which act to inhibit conduction of nerve impulses from sensory nerves, are often used to treat minor burns, as are topical antihistamines, which act to depress cutaneous pain and itch receptors.

Severe burns should be managed in the hospital.

Other Recommendations

Honey dressings are reported to be an effective treatment for burns. Honey's high viscosity enables it to form a physical barrier, which prevents bacterial colonization and reduces the incidence of infections in wounds. The antibacterial effects are reportedly due to hydrogen peroxide, which is produced due to the action of the enzyme glucose oxidase secreted by bees. The viscous barrier formed by honey creates a moist environment, which helps quicken wound healing. Nutrients in honey, such as levulose and fructose, improve the local nutrition and promote epithelialization (the healing of the epithelial tissue).

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