Burns are a global public health problem with the World Health Organization (WHO) estimating that 180 000 deaths are caused annually by burns. Your patients may be completely clueless on how to differentiate between the types of burns or how to treat the varying degrees thereof.
A burn is an injury to the skin caused by heat, electricity, radiation, friction, or chemicals. This can affect all or just some of the layer of the skin. The depth of a burn injury describes the anatomical extent of tissue injury.
1ST DEGREE BURN
This is the most minor and common burn. “Many patients have experienced it as a minor sunburn,” explained Pray et al. in Treating Burns in the Pharmacy (published online on US Pharmacist, 19 Oct 2011). “It can also occur from exposure to low intensity heat or a short exposure to a more intense heat (e.g., an explosion). As the shallowest burn, its damage is limited to the epidermis, the skin’s outermost layer. The burn is pink to red, and most are painful.” These burns can be localised for example, a small mark on a patient’s hand where they bumped against a hot pot, or they can cover a large area like a mild sunburn across the back. First degree burns do not penetrate the skin or cause blisters, rather the skin appears dry. “Since the skin is not broken, there is little risk of infection. Skin can exfoliate, but it usually returns to normal in a 3-6 days without causing residual scarring,” said Pray et al.
In the event that a patient has suffered a first-degree burn, Crozer Health advised that the burn be soaked in cold water for about five minutes, as this helps reduce swelling by pulling the heat away from burned skin. University of California (UC) San Diego Health Regional Burn Center stressed that ice is not recommended as an initial treatment for burns because it can decrease circulation and cause more harm to the burn. “Patients should avoid applying any food-based products on the burns as this may result in infection and make it more difficult to clean the wound. Mild soap and warm water should be used daily to clean the wound, this can be done in the bath or shower,” the Burn Center advised. Crozer Health recommended the skin be treated with aloe vera or an antibiotic ointment, wrapped loosely in a dry gauze bandage, and an over the counter (OTC) pain reliever can assist with pain and swelling.
2ND DEGREE BURN
This type of burn can be divided into two categories, explained Masood et al. in Burn Cases, Their Management and Complications: A Review (published in International Current Pharmaceutical Journal. 5.103.):
A superficial partial thickness burn: “They usually invade into the superficial papillary dermis. They are characterised with reddish blisters. When pressure is applied, the blisters may shrink, and their healing time is 2-3 weeks.”
Deep partial thickness burns: “They penetrate the reticular dermis and are yellow or white in colour, rough in nature and are very painful. They require more than three weeks for complete healing.”
“It is critical in pharmacist triage to determine whether the second-degree burn is superficial or deep, as only superficial second-degree burns are self-treatable,” cautioned Pray et al. A small second-degree burn can be treated similarly to a first-degree burn, but Crozer Health advised holding the burn in cool water for about 15 minutes. Depending on the severity of the burn University of Rochester Medical Center advised that treatment may include:
- A wet cloth soaked with cold water (cold compress) held to the skin, to ease pain.
- Antibacterial cream, to help prevent infection.
- Other creams, to lessen pain and swelling.
- Non-stick dressing or bandage that’s changed every day.
- OTC medicine such as acetaminophen or ibuprofen for pain and swelling.
- Keeping the area elevated (for instance, an arm or leg) to lessen pain and swelling.
- Giving a tetanus vaccine.
The UC San Diego Health Burn Center explained that there are several topical medications that may be used in care of second-degree burns. Some are topical antibiotics while others are chemical enzymatics that aid in the debridement of the burn wound. “As the wound heals there is a white to yellow scab that forms. This must come off as best as possible so that the wound will heal. It can be a long process taking two weeks to resolve. If looked after, second degree burns often heal without the need for surgery, however, if the burn takes too long to heal, a skin graft may be necessary.
3RD DEGREE BURN
Also referred to as full-thickness burns, this type of burn destroys the epidermis and dermis. Stanford Children’s Health explained that they may go into the innermost layer of skin, the subcutaneous tissue, with the burn site appearing white or blackened and charred. When bones, muscles, or tendons are burned, John Hopkins Medicine said that it may be referred to as a fourth-degree burn, and that a patient will have no feeling in the area since the nerve endings are destroyed.
Third degree burns require immediate medical attention. MedBroadcast advised that the goal is to prevent infection, which is one of the mostsignificant problems in burn patients. “Cold water should not be applied and clothing that's stuck to the patient shouldn't be removed. The burn should be loosely covered with a clean, dry dressing such as a handkerchief, pillowcase, or a sheet. It's important for the patient to keep warm after the burn. Wounds that extend deep into the dermis tend to heal very poorly and slowly because no keratinocytes remain to reform the epithelium. For such wounds, skin grafting with an autograft is the treatment of choice, since the patient donates their own tissue, there is no risk of rejection,” said Singh et al. in Treatment Strategies in Burn Wounds: An Overview (published in Research Journal of Pharmacology and Pharmacodynamics 5(6): 2013).