A Handle on your Health: Burns: Identification & treatment

Everyone gets occasional burns. Sometimes these are just annoying little burns from bumping into a hot stove but sometimes they are much much more serious. Lets go over burn treatments and when you should seek more advanced medical care.

We classify burns into three types. First-degree burns involve only the outside layer of skin, the epidermis, and cause local redness and pain. Second-degree burns involve the deeper layer of skin, the dermis, and also cause redness and pain — lots of pain — but usually cause blisters too. Third-degree burns are the worst kind of burns and involve tissue deeper than the skin into the underlying muscle, nerves and sometimes bone. The destruction in third degree burns can be so significant that they’re actually less painful because the nerves are burned and can’t send pain signals to the brain.

Examples of first-degree burns are sunburns that don’t blister or spilling hot coffee on your hand that just causes redness and pain without blisters. While these burns are no fun they can usually be managed at home with over the counter remedies.  They make topical creams and sprays that help ease the pain of these burns — Solarcaine, Bacitracin, burn gel with lidocaine. Your body will do the rest of the healing and there is no scarring.  

Please don’t dunk your burn into ice water. Ice water causes vasoconstriction and can reduce blood flow to the affected area and worsen the burn. You can run cool tap water over your burn, though. If you have an aloe vera plant at home, you can break off a piece and apply it to your burn, as it will help ease the pain. Honey can be used too on the burn as it has anti-inflammatory and anti-bacterial properties. I have seen patients come in with mustard or butter or mayonnaise spread over their burns. I really can’t tell you that those condiments help burns. I also can’t recommend lavender oil or tea bags or potatoes or onion juice either but I can say none of this stuff will hurt.  

Second-degree burns are much more significant than first degree burns. These burns usually blister up and are quite painful. These burns can be mild and involve only a small surface area or can be severe requiring transfer to a burn center. If you’ve ever had a bad sunburn with blisters you have experienced a second-degree burn. You probably didn’t seek medical attention, though, as this can be managed at home. 

Second-degree burns that involve a large area of skin or the face or joint surfaces need medical attention by a doctor. These more serious burns are more likely to get infected or result in scarring and so we are more aggressive in treating them.  Sometimes we can treat them at the local clinic or ER but often times we transfer these patients to burn centers where specialists can follow the treatment. You can use the same topical agents we use in first-degree burns to help healing and pain.  We also use silvedene cream or other antibiotic creams as well as oral pain medicines. Tetanus vaccine needs to be updated if it’s been 10 years or more.

Third-degree burns are the worst. These burns destroy deep into tissue other than skin. As stated before, these burns destroy nerves and so oddly they can be painless or less painful than second degree burns.  These burns are usually white or black as there is no blood flow to the burn area because the blood vessels have been burned too. Third-degree burns require transfer to a burn center due to the depth of tissue destruction. When we treat burns the two biggest things we are trying to do is prevent infection and preserve function. We also worry about scarring and how it looks cosmetically but a good plastic surgeon can often revise a scar later if it’s needed.  

There are also chemical burns and electrical burns but we’ll save those for another day.

Do I need to remind you not to dunk your burn in ice water again? Seek medical attention if the burn area is big or involves sensitive areas like hands, face or groin.  Use topical antibiotic creams so the burn wound doesn’t get infected. Update your tetanus vaccine. If your burns come from a fire and you worry that you inhaled smoke don’t hesitate to be evaluated by a doctor. Use sunscreen when you’re enjoying the Texas sun and if you’re going to try fire walking I suggest going with a guru that has five star Google reviews. Be safe this summer.

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Dr. John Turner is a family medicine and emergency medicine doctor with 25 years of experience. He is also the owner of My Primary Care Clinic and My Emergency Room 24/7 here in Hays County. Dr. Turner may be reached at 512-667-6087.