Burns - Western SummaryWestern Medicine Summary

Western Medicine

Western Summary

Burn wounds are typically painful and can lead to severe scarring

Symptoms

“Burn” is a general term used to describe heat or chemical induced  damage to the skin and deeper tissues. The severity of burns are grouped according the depth of skin damage: 

First degree (superficial) burns: the damage is limited the upper layers of the skin (epidermis). The skin is red, warm, painful, and turns white when touched. There is no blister. The pain usually lasts around 3 days. 

Second degree (partial thickness) burns: the damage extends into some portions of the dermis. Blisters are common and very painful. Healing can take up to 2 months and there may be scarring. If the sweat glands are destroyed, the skin may be dry to the touch. If the hair follicles stem cells are destroyed, there may be permanent hair loss.

Third (full thickness) burns: the damage extends through all skin layers. Nerve endings, small blood vessels, hair follicles, oil glands, apocrine glands, and sweat glands may be all destroyed. The affected site is often dark purple, brown, even black, and is usually firm, stiff, and painless.

Fourth degree burns: the damage involves the tissue below the skin, such as muscle, tendon and bone. The site is usually black, leathery and painless. The burned tissue is usually not salvageable. 

In third and fourth degree burns, and occasionally second degree burns, there is a higher risk for infections, difficulty in temperature regulation, and electrolyte abnormalities.

Causes

Burns can be caused by a variety of sources such as heat, electricity, chemicals (acids and bases), friction or radiation. The damage of the skin and deeper tissue is proportional to the time they are in contact with the damaging source.

Treatments

Several medications may be used to treat burns depending on the depth of the burn:

  • In first and second degree burns, topical antibiotics may be used to treat and prevent skin infections
  • Topical aloe vera[1,2] and topical medical-grade honey[3] are helpful in 1st and 2nd degree burn wound healing. 
  • Silver sulfadiazine may be used to decrease infection and help wound healing. 
  • In first degree burns, cooling using cool water or wet towel may reduce burn depth and pain immediately after the injury. Ice should not be used because it may cause more tissue injury.
  • Oral or IV pain medications may be needed for pain control in burn injuries
  • Depending on the injury depth and how much of the body is affected, hospitalization for supportive care in hydration, temperature regulation, nutrition may be necessary. Antibiotics may be given to prevent and treat infections.
  • For second degree burns with blisters, the blister roof should be kept in place as it since the blister roof can act as a natural protective agent. If the blister is drained, the roof should be kept intact. 
  • Deeper or more extensive burns require hospitalization and care by a specialized burn unit or a surgical intensive care unit. The treatment may involve surgical skin grafting and specialized wound care. 

1.    Bahramsoltani R, Farzaei MH, Rahimi R. Medicinal plants and their natural components as future drugs for the treatment of burn wounds: an integrative review. Arch Dermatol Res.2014;306(7):601-617; PMID: 24895176.

2.    Maenthaisong R, Chaiyakunapruk N, Niruntraporn S, et al. The efficacy of aloe vera used for burn wound healing: a systematic review. Burns.2007;33(6):713-718; PMID: 17499928.

3.    Jull AB, Cullum N, Dumville JC, et al. Honey as a topical treatment for wounds. Cochrane Database Syst Rev.2015;3:CD005083; PMID: 25742878.