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Burn Care. What You Should do at Home

Approximately 500,000 patients In the United States seek medical care for burns each year and 92% are treated as out-patients, according to theAmerican Family Physician.  Burns are classified by depth.

A first degree burn.  Ouch

Superficial burns are called first degree. They are localized to the outer (epidermal) layer and are painful, red and dry.  These burns do not blister and they take about 3 days to heal. A bad sunburn or quick stove burn is a first degree burn.

Partial thickness burns are called second degree. The epidermal layer is destroyed and they are very painful and usually blister.  Most will heal within three weeks or sooner.

2nd degree burn with blister 2nd degree burn and after healing

Deep partial thickness burns involve the reticular dermis underneath the epidermal layer and they are usually dry. These are third degree burns. They take more than three weeks to heal and often cause loss of skin and scarring.  Deep partial thickness burns should receive immediate medical attention and sometimes even need skin grafting.

Deep third degree burn

Full thickness burns extend through the entire dermis and into underlying fat and connective tissue and require admission to a  burn center for treatment.  Surgical intervention and skin grafting are needed.

For all types of burns the first thing to do is minimize the extent of burning, clean the wound and address pain.  For scalds or sunburn remove the clothing immediately, including watches, belts, jewelry and diapers.  Actively cool the burn surface with running tap water for at least 20 minutes.  Ice should not be used because it causes the vessels to constrict and may increase the tissue injury.  Using regular tap water (instead of sterile water) does not increase infections.  Superficial burns do not require dressings for healing but covering the burn with wet gauze and aloe vera cream can help with pain.  

What if it's a 2nd degree burn with blistering? If it is a small blister just leave it.  It it is large and causing pain it is OK to puncture it or remove the blister, allowing the dermis underneath to heal.  

There are pros and cons with every topical antibiotic cream used in burns.  If you are treating at home, mupirocin (Bactroban) is the best for antimicrobial coverage and it can be used on the face.  It does require a prescription. Even vaseline can help seal in moisture while it heals. The burn should be checked frequently and a new dressing applied.

At the emergency department they will often used advanced dressings that are kept on the burn for 14 days and it is especially helpful with children.  

Remember to give pain medicine like acetaminophen (Tylenol) or Nsaids (ibuprofen, Motrin) early for superficial and partial thickness burns. 

If you aren't sure how deep the burn is, or it covers a large portion of the body, go to the ER.  Inhalation, electrical or chemical burns need professional treatment. Burns to the face, hands, feet, major joints, genitalia need professional treatment. 


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