Skin Burns

By Dr. Loretta Lanphier, ND, CN, HHP, CH

The skin is the largest organ of the body, and two of its many functions are to protect us from infectious invaders in the environment around us, and to keep us hydrated by locking in necessary bodily fluids. When the skin is damaged by a burn, that protective barrier is compromised, and we are at greater risk for infections and dehydration. Burns come in several different forms, and can range from minor to life threatening. The good news is that many burns can be prevented by taking some practical, common-sense steps. Let’s see what we can discover about burns, how to treat them, and best of all, how to avoid them.

What Are Burns?

When the skin or other tissues are damaged by thermal, electrical, chemical, or radiational energy or heat, the injuries are classified as a burn. Most burns occur at home, on the job, or in conjunction with a motor vehicle accident. Unfortunately, some burns are also the result of abuse to children, spouses, the elderly, and others. Burns compose a high percentage of accidental injuries in the United States, and approximately 1-2 million Americans seek treatment for a burn annually. About 60,000 are burned badly enough to need hospitalization, and approximately 10,000 deaths per year occur from burns, most of them due to complications from infection. Many major hospitals have burn units staffed by health care workers that are specially trained to handle the treatment of burns.

What Are the Symptoms of Burns?

Signs of a burn will vary depending on the type of burn, the location, and the severity of the burn, as well as other factors such as the overall health of the victim. Burns are generally classified by the degree of the damage and the amount of bodily surface that is involved:

Degrees of burns are categorized as follows:

  • First-degree burns: These are the least serious types, and they only damage the outer most layer of skin known as the epidermis. The skin appears as reddened, and it may exhibit swelling and produce pain as well. Most first-degree burns can be handled through self-care, using basic first aide. However, even first-degree burns may lead to infection and complications if not kept clean. If possible, run cool water on a first-degree burn for approximately five minutes. Do not apply ice, as this can increase the tissue damage.
  • Second-degree burns: This is a more serious form of burn that involves damage to the epidermis and the second layer of skin called the dermis. Second-degree burns can produce severe pain, as well as blisters that may break and ooze. These take much longer to heal, and the likelihood of infection is much greater than for more minor burns. Unless second-degree burns are very small and localized, treatment and evaluation at an emergency room is advised. If you choose at home care, be sure to cleanse the wound with soap and water, apply an antibiotic ointment, and cover with a gauze bandage to protect the burn while it heals.
  • Third-degree burns: These are the most severe types of burns, and they always require immediate medical care. Do not try to treat these at home. Third-degree burns involve all the layers of the skin, and often burn through the skin and can involve damage to tissues below the skin such as muscles, tendons, and bones. There is usually minimal pain with third-degree burns because the nerve-endings are typically destroyed. The site of the burn may appear charred, ashen, or what is often described as “leathery” in appearance. Special care is needed to remove the dead skin, a process called debridement, to prevent dehydration, and to protect from the very real danger of infection as well. Infection is the number one cause of death when it comes to serious burn victims.

Amount of Body Surface Involved: The severity of a burn is also rated by the percentage of Body Surface Area (BSA) that is involved:

  • Critical or major burns are defined by third-degree burns on greater than 10% of the body surface, or second-degree burns on over 25% of an adult’s body or 20% of a child’s body.
  • Moderate burns are the label given if the injuries consist of first or second-degree burns on 15-25% BSA on an adult or 10-20% BSA on a child. Moderate is also used if there are third-degree burns on an adult or a child that cover only 2-10% BSA.

The most important thing to remember regarding any burn, especially more serious ones, is to never apply butter, shortening, or any type of salve to the burn. Many people are misinformed in this matter, and are under the impression that this may help. In reality, the application of such substances only locks in the heat, making it harder for it to escape from the burned area. The result is that the heat moves inward, and can actually penetrate deeper into the skin or beyond.

Burns can also be analyzed by either typical or atypical patterns. Unintentional burns are usually typical, while burns that may be the result of abuse are atypical. Intentional burns are often found in locations that are usually not exposed, such as the buttocks. Another tip for intentional burns from abuse are third-degree burns that are small and focused, such as those from a cigarette.

How Can I Determine if a Burn is Infected?

Infection is by far the greatest danger involving critical burns. A person who is burned badly, especially over a large part of the body, is at very high risk for infection, and it is important that we know signs to look for that may indicate infection. This is particularly challenging with burn wounds, as burns themselves may act like an infection. For example, both burns and infected wounds may appear red and warm to the touch, making it difficult to know if a burn is infected or not. Here are a few things to watch out for that may be symptoms of infection:

  • Fever.
  • Pus or discharge, often greenish.
  • Any changes in color in or near the site of the burn, especially any purplish discoloration.

It is also important to look out for dehydration in burn victims. Signs of dehydration may include:

  • Excessive thirst.
  • Reduced urination, both in frequency and volume.
  • Abnormally dry skin.
  • Dizziness or lightheadedness.
  • Fatigue

What Are the Major Types of Burns?

Most burns fall under four major categories:

  • Thermal: Examples of thermal burns include fire, steam, scalding liquids, and contact with hot metal. Structure fires and automobile accidents are common sources of thermal burns. Thermal fires often put the victim at risk for smoke inhalation and respiratory damage that may also occur during the fire. In fact, most fatalities in structure fires occur from the noxious gases and high temperatures that are produced during the fire, and not from burns. If you ever get caught in a house fire, crawl out and stay down below the smoke line. The temperature at ground level in a house fire may be 100F, but at standing height it can reach 600F, which is instantly fatal.
  • Electrical: Burns from electricity can be very damaging to body tissues, as the temperatures produced can be extremely high. Electrical burns can occur from contact with man-made electrical sources, or from lightning. Contact with electrical current can also disrupt the heart and nervous system and result in injury or death.
  • Chemical: Chemical burns are caused by coming in contact with caustic substances that chemically burn tissues. This can occur on the skin, or internally if these substances are inhaled. These types of burns commonly occur in an occupational setting, but they can happen at home too, especially with the increasing numbers of toxic home cleaning products that are found in many homes.
  • Radiation: Sunburn is the most common form of radiation burn, but this can also occur during high doses of artificial radiation, such as when getting x-rays or a CT scan. Sunburn is often not the first thing folks thing of when considering burns, but it is one of the most common and hazardous forms of burn. The dramatic increase in skin cancer in recent years is largely the result of excessive exposure to the sun. While all types of burns increase your likelihood of developing skin cancer, radiation from the sun is particularly damaging to the DNA of the skin, and is a major risk factor for cancer. Do not sacrifice your health for the dictates of fashion. A tan may be aesthetically pleasing, but the risk is simply not worth it.

What Is the Best Way to Treat Burns?

Minor burns can mostly be self-treated. Keeping the wound clean and protection from infection are the most critical factors. Most burns will heal on their own within 10-20 days, depending on the location and intensity of the burn. Two natural substances that will encourage healing and soothe the irritation are aloe vera and tea tree oil.

Major burns will require you to visit your health care provider, and in most cases it will be necessary to be hospitalized, mainly to avoid infection, dehydration, and to have the dead skin removed as the healing process unfolds (debridement). Nutritionally, it is very important that burn victims get plenty of water, protein, and other nutrients in order to help the skin heal and rebuild faster. A diet high in fruits and vegetables that are rich in antioxidants, vitamins, and minerals is essential. I would also suggest supplementing with a whey protein product to boost protein levels, which are integral to the renewal process of the skin.

Critical burns may necessitate surgery to restore tissues, such as skin grafts, or plastic surgery to repair scarring and other skin damage. The process for recovery from a serious burn may take a long time, with multiple surgeries in some cases.

As is the case with any illness or injury, keeping your immune system strong and vibrant will enable you to experience less damage and heal faster, and burns are no exception. Many burns are the result of accidents, and none of us can fully protect ourselves from accidents. However, by living wisely and pursuing a lifestyle and philosophy of wellness, we will give our body, mind, and spirit the best fighting chance possible at keeping us healthy and repairing illness and injury effectively.

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