Saving Skin
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Saving Skin

Learn about the different types of burn injuries and how they can be treated.

A year ago, Lina, my domestic helper, sustained a burn injury while cooking. As she was lifting the cover from the wok in which she was braising fish, steam escaped and scalded her right forearm badly. Applying antiseptic cream on the wound was not sufficient to prevent angry blisters from forming. Not long after, the affected skin started to peel, making the area look raw.

Worried that the injury was serious, I took Lina to the Accident & Emergency department of the nearest hospital. There, the doctor assured us the burn was not deep and less severe than it appeared. After her wound was bandaged, Lina was given a tetanus shot as well as a referral to the hospital’s Burns Department should the wound become infected in the next fortnight. Fortunately, the wound healed without any other issue.

When burns occur, you may not always be clear about the right course of action. Most burns take place at home or in the office. “The most common burn injuries I encounter are hot water, soup and oil burns,” affirms Dr Karen Sng, a plastic surgeon from The Plastic Surgery Practice in Paragon Medical Suites. Such burns tend to be fairly minor and require minimal care. Most of the time, these cases are first- and second-degree burns (see sidebar on page 60 for an explanation of how burns are classified) that can be managed with home remedies.

Burns can result in complications if not properly managed. This is because a burn damages the skin, the body’s protective barrier. This leaves you vulnerable to bacterial infections. Skin also helps control the body’s temperature; when a large mass of it is injured, you lose body heat. Deep burns of the third and fourth degrees can limit bone and joint movement and lead to severe scarring. These would require specialised care.

Treating burns

How you treat a burn depends on its severity.

According to the WebMD website, factors to look out for are depth and size of the wound, type of burn (thermal, electrical, chemical, radiation or friction), the body part affected, age and health of the victim, as well as any other injuries.

For example, The Mayo Clinic identifies major burn injuries as deep wounds that make the skin dry and leathery. They may appear charred, are larger than 8cm in diameter or cover the hands, feet, face, groin, buttocks or a major joint. These need immediate medical attention. Minor burns that don’t require emergency care are smaller, have a superficial redness (like a sunburn) and often break out in blisters.

In the meantime, the first step you need to take for any burn injury is to stop the burning:

Heat burns Smother any flames by covering them with a blanket or water. If your clothing catches fire, do not run; instead, stop, drop and roll on the ground to smother the flames.

Liquid scald burns Run cool tap water over the area for 10–20 minutes. Do not use ice on it.

Electrical burns If someone has suffered electrical burns, the first thing to do is to separate him from the power source. Then check for breathing and a heartbeat. If the person is not breathing or does not have a heartbeat, call for an ambulance.

Chemical burns These can occur through contact with household products such as bleach, toilet bowl cleaners, metal cleaners or pool chlorinators. See a doctor for treatment as such burns can be deceptive, and can result in deep tissue damage that is not immediately apparent.

Then, look for other injuries. Remove any jewellery or clothing at the site of the burn as swelling may occur. Finally, elevate the burnt area - above heart level, if possible. Raising a burnt limb reduces the pressure inside it by draining fluid.

Home remedies

For those suffering from first- and seconddegree burns, dermatologist Dr Wong Su-Ni, from Dr SN Wong Skin, Hair, Nails & Laser Specialist Clinic in Mount Elizabeth Medical Centre, says, “Cool down the area quickly by running cold water over it or using cold compresses, followed by an anti-inflammatory cream regularly, starting within 24 hours, until the redness subsides.”

A common mistake is not cooling the area down immediately. “Retained heat continues to cause damage and incite inflammation,” she adds. Other common mistakes include delaying the use of anti-inflammatory creams (“the window of opportunity is within the first 24 hours”) and breaking blisters that form (“this increases the risk of bacterial infection, which increases the risk of ugly scarring”).

Dr Sng adds that most burns can be treated conservatively with dressings, while skin grafts are used for third-degree burns. However, “post-burn scarring is possible, and scar treatment should be initiated once the burn heals”. She also suggests that burn patients who are diabetic see a doctor as early as possible because they are more susceptible to infections.

For home treatment of first-degree burns or sunburns:

  • Apply a damp, cool cloth on the burnt area; alternatively, hold the area under running water until the pain subsides — you should do so for at least 10–15 minutes
  • Take frequent cool showers
  • Apply lotion that contains aloe vera to the burnt area to soothe the pain
  • When the injury is two or three days old, apply aloe vera juice over to ease the discomfort and hasten wound healing
  • A newly burnt area can get sunburnt easily, so keep it shielded from the sun; use sunscreen on the area when you head outdoors

For second-degree burns, steps you can take include:

  • Rinse burnt skin with cool water until the pain stops
  • Do not use ice or iced water as this may damage the tissue
  • Do not break blisters as this can lead to infection
  • If the burnt skin or blisters have not broken open, bandage the area
  • If the burn is on a leg or arm, keep the limb raised
  • See a doctor if the pain worsens, or you have difficulty breathing or develop signs of infection (such as increased pain and swelling, pus and fever)

Burn patients who are diabetic should see a doctor as early as possible because they are more susceptible to infections.

When burns are major

Third- and fourth-degree burns must be treated by medical professionals as they have a high risk of infection and may cause patients to go into shock. In these burns, the skin can turn white or black. If major blood vessels are destroyed, skin grafting or other surgical procedures may be required to replace the protective layer of skin that was burnt. Skin grafting involves taking healthy skin from another area of the body or from a donor to cover damaged skin.

Severe burns involving large parts of the body may need more intensive treatments, such as intravenous antibiotics to prevent infection or IV fluids to replace lost fluids. Pain as a result of the burn also needs to be managed, depending on the type and severity of the pain. However, pain intensity is not necessarily an indication of the seriousness of the injury. In third-degree burns, for example, there is often no pain in the affected area as the nerve endings may have been destroyed.

While most burns heal without leaving behind lasting problems, deeper and more severe burns can result in scars as well as other complications. In these instances, seeking medical attention quickly is vital to boost chances of recovery; this can even have an impact on survival.

First Burns of the first layer of the skin.
Second (2 types) In superficial, partial-thickness burns, the first and second layers of skin are injured. Blisters may develop and the pain can be excruciating.

Deep partial-thickness burns injure deeper skin layers.
Third All the skin layers and tissue under the skin are damaged. This class of burns always requires medical attention.
Fourth The burn extends through the skin to injure muscles, ligaments, tendons, nerves, blood vessels, and bones. This class of burns always requires medical treatment.