Skin Burn: Answers to My Patients' 5 Most Common Questions
4th of July is a wonderful time in the U.S. As we remember our heritage, we also enjoy the Americana of getting outdoors, throwing food on the grill, and of course fireworks. As an American, I enjoyed all of those things this week. As a doctor, however, I fretted over something each of these summer pastimes has in common - burns.
1. "How bad is my burn?"
Burns are classified according to their penetration into the body:
- First Degree Burns: A first degree, or superficial burn involves the outer layer of the skin known as the epidermis. A typical burn in this category is a sunburn without blisters.
- Second Degree Burns: Second degree burns extend through the epidermis and are further classified as partial or full thickness.
- Partial Thickness Burns: Partial thickness burns extend into the deeper skin layer, the dermis, and may involve blisters. These burns may also have a wet appearance.
- Full Thickness Burns: Full thickness burns extend deeper into the dermis skin layers. These burns are typically dry in appearance, may be white or red in color and sensation may be diminished due to nerve damage.
- Third Degree Burns: Third degree burns extend through the skin and into the underlying muscle and/or fat. They are not painful due to damage to the nerves. These burns do not blanch due to destruction of the blood supply and may be white or charred.
- Fourth Degree Burns: Some sources add a fourth degree to classification which involves extensive involvement of muscle and bone.
2. "Should blisters be popped?"
Partial thickness burns often blister. As a reaction to the burn in the deeper epidermal layers, fluid is produced and collects between this layer of skin. This fluid, known as serous fluid, is a neutral electrolyte-rich liquid that aids in healing. The blister surrounds the burn like a protective bubble protecting it from further injury and aiding in healing. While the blister can be cumbersome, it should not be removed if possible. If it does burst or if it needs to be popped, the skin should be opened and then a generous layer of antibiotic ointment or cream should be applied atop the burn. The redundant skin should be removed as not to pose a foothold for infection.
3. "What should I put on a burn?"
After a burn occurs suddenly, it is not uncommon for chaos to ensue. There is a knee-jerk response to put something on it. The most important thing in treating a burn is to remove anything that could worsen the burn. Remove clothing that may have burned or that may be saturated with burning water. Care should be taken with anything melted to the skin as it may remove delicate skin with it if pulled off. One old home remedy is to put butter on a burn. While butter is cool and spreadable, it may invite in an infection if left on the burn. Probably the best immediate treatment is cool water to cool the burning skin and block some of the inflammation. Water will evaporate or drip off the skin without leaving a residue and can make way for application of an ointment or cream that has antibiotic properties. General antibiotic ointment such as Neosporin is fine as secondary care applied with a sterile non-stick dressing. Silvadene cream is often prescribed for burns. This cream is more light and easier to apply and remove. First and second degree burns can be quite painful. Removal of bandages and cleaning can be excruciating and a lighter cream and non-sick dressing can make this process easier.
4. "Do I really need an antibiotic?"
You may have questioned at this point why antibiotics need to be applied to a burn. With damage to the skin and standing fluid, a burn is an easy target for infection. This complication can make a bad situation worse and fast-track the infection into the blood stream (sepsis) which can be fatal. For this reason, after first aid, an antibiotic barrier is important. Burns also cause dehydration. Even minor burns or burns to small areas can cause massive shifts in the body's fluid stores. This can lead to dehydration. Aggressive hydration through drinking fluids or IV fluids in the hospital are an important part of after-burn care.
5. "My burn's pretty bad. Should I see a doctor?"
Burns can be tricky. Some burns that are horribly painful are relatively minor. In contrast, burns over certain areas can be serious or burns that are not painful can be much more significant than they seem. Burns that involve the eyes should be evaluated by a health professional. Burns over underlying tendons such as the hands and feet have the potential to cause scaring and loss of function if not treated appropriately.Burns that involve charring of tissue or burns that are surprisingly not painful for their severity should be evaluated. In these burns, nerve and tissue damage has likely taken place. Increasing redness in a burn a couple days or more after the burn is concerning for a secondary infection and should be quickly evaluated.