Burns

People who suffer severe burns may take years to recover physically and emotionally. Each burn survivor copes with his or her injury differently, depending on how serious the 

burn is and the person’s personality. Along with the physical pain and change in appearance, a burn survivor may experience loss (e.g., temporary or permanent leave from work, inability to care for family, being unable to engage in leisure activities), fear about the future, anxiety about recovery and concern about returning to a normal life.

There are two important factors that have consistently been found to influence psychological and social adjustment following burn injuries: the enduring quality of family and social support received by the burn survivor and the willingness on the part of the survivor to take social risks.

Conversely, factors associated with poor psychosocial adjustment by a burn survivor include:

• Social shyness
• An acceptance within the family of the survivor’s dependence (learned helplessness)
• Lack of family cohesion and high conflict within the survivor’s family

A full physical and psychological recovery from a serious burn can be a difficult process and involves major adjustments as a survivor works to develop a new life, a new body image, and new ways to feel confident. Some strategies for recovering emotionally from a severe burn include the following:

• Include all members of the family in all aspects of treatment.
• Practise autonomy: doing things for yourself in a new way. 
• Learn to manage predictable reactions from naïve observers (e.g., staring, questions about what caused the burn).
• Practise social skills and social risk-taking. James Partridge, director of Changing Faces, an organization that assists people with facial disfigurement, recommends adopting a social skills technique called “3-2-1-GO!” in which the survivor plans for uncomfortable social situations by thinking of 3 things to do when someone stares at them, 2 things to say when someone asks them what happened (to cause their scars), and 1 thing to think if someone turns away from them. Other coping techniques include going out with family members or friends to feel less conspicuous and reminding yourself that who you are on the inside has not changed, your skin will continue to heal up to two years after the burn and the scars will become less obvious over time.
• Identify positively as a burn survivor, rather than as a burn patient or victim.
• Celebrate rehabilitation gains and social accomplishments.
• Understand that each burn survivor is a human being who can be strong and competent, optimistic and autonomous, but also experience moments of sadness, despair or rage.
• Remind yourself that soon you will be comfortable in a new routine, or a “new normal” life. There will be life after the hospital, after the end of rehabilitation and after the pressure garments come off! This new life can be just as good or even better than the one that existed before the burn.
• Be prepared for the emotions at various phases of recovery.
• Connect with others who have had similar experiences. Some hospitals and associations run support groups. 

The information in this section has been gathered from existing peer-reviewed and other literature and has been reviewed by expert dermatologists on the CSPA Medical Advisory Board.

A burn is a type of skin injury that occurs when the skin or other tissue is damaged by coming in contact with:

• Chemicals, such as acids or alkalis (pronounced al-ka-lies)
• Very hot surfaces, liquids, foods, air or steam
• Fire
• Radiation, such as overexposure to x-rays and sunlight
• Electricity
• Hard surfaces, causing a friction burn

Although the skin is usually the area that is burned, the tissues underneath and internal organs can also be affected. Health-care professionals determine the severity of a burn based on how deep it goes and how much of the body it covers: the deeper and more widespread a burn is, the more serious it is. Burns are generally categorized as first, second, third or fourth degree. Many burns are superficial and, although painful, heal quickly and easily. However, very severe burns can be life-threatening and cause significant scarring.

Treatment for burns depends on the severity of the injury and ranges from immediate attention (first aid) and over-the-counter creams to prescriptions, emergency medical care and ongoing management.

First Aid

First- and Second-degree Burns

Applying first aid to first- and second-degree burns is an important step to healing properly:

• Act quickly!
• If the victim is a child or an adult over 70, seek immediate medical assistance.
• First- and second-degree burns should be run under cool water for at least 15 minutes.
• NEVER apply ice or butter to burns or break any blisters because you risk further damaging the skin.
• Cover the affected area with a sterile bandage.

After applying first aid, less severe burns can usually be treated at home:

• For adults, use pain medication as needed. For children, use the pain medication recommended by hospital medical staff.
• Second-degree burns can be treated with prescription antibiotic creams or pills, as well as painkillers.

Third- and Fourth-degree Burns

Knowing what to do when someone suffers a serious burn can save his or her life. Below are the first-aid procedures for third- and fourth-degree burns:

• Call 911 and perform CPR if there are no signs of breathing and a pulse.
• Elevate the burns above the heart, if possible, and cover them with a cool, moist, sterile bandage or a clean, moist cloth or towel.
• NEVER remove burned clothing or immerse severe burns in cold water.

Once first-aid treatment has been applied and the person with the burn has been assessed by a physician, longer-term burn treatment can begin. Specialized treatment for severe burn cases may include:

• Placement of a breathing tube if the person’s airways or lungs have been damaged by hot air or flames
• Administration of fluids through an intravenous tube
• Immunization with tetanus vaccine and use of antibiotics to prevent infection
• Covering the burned area with antibiotic ointments and bandages
• Debridement, or removal of dead tissue
• Skin grafting, a procedure done in an operating room that involves transferring a patch of non-burned skin to the burned area
• Physical and occupational therapy to keep burn areas flexible and to manage scarring
• Made-to-fit elasticized pressure garments to minimize the amount of scarring following a burn injury by decreasing hypertrophic (excessive) scar growth; they generally need to be worn for one to two years following the injury.

The goals of burn treatments include relieving pain or itching, preventing infection and minimizing permanent scarring. Many burn treatments are available without a prescription.

Topical Treatments (Creams, Gels, Ointments)

Bacitracin is an antibiotic cream or ointment applied to the skin to help treat and prevent infection and aid in the healing of burns. A small amount is applied to the (clean) affected area, 1-3 times daily, for up to a week. Do not use bacitracin if you are sensitive or allergic to this type of antibiotic.

Silver sulfadiazine is a prescription antibacterial cream used for treating burns, especially for treating and preventing infection of serious burns. Each day, after cleaning the wound, apply a 3-5 mm-thick layer of cream. The cream should not be used during the late stages of pregnancy or in premature or newborn infants. The cream may affect scabbing and/or the appearance of the burn wounds. Common side effects include burning, rash or itching where the cream is applied. Leukopenia (low white blood cell count) is also common; careful monitoring of the blood is required.

Systemic Treatments

Analgesics (e.g., acetaminophen/paracetamol) offer temporary relief of mild to moderate pain. Acetaminophen and ibuprofen are available without a prescription. The pills or capsules are taken orally as needed, with doses separated by 4-6 hours. Some people may experience nausea, heartburn, dizziness and rash as side effects. An overdose of acetaminophen can cause serious liver damage.

Diphenhydramine is an antihistamine available in pill form without a prescription that can be used to treat severe itching. This medication should be taken orally, as directed (usually every 4-6 hours). A side effect is drowsiness.

New medications and treatments are regularly being tested for burns. To learn about the latest in burn care, visit our clinical trials page [link to CSPA clinical trials page].

Ongoing Management

If you are recovering from a burn, see a doctor when you need help controlling the pain or are unsure of how to care for your burn.

A person who is burned is often left with a scar after the skin is done healing. If a person has had a skin graft to heal the burn, that site may also scar. Depending on how bad the burn was, the scar may be hardly noticeable or very noticeable.

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Scar tissue is made of collagen, the tough material manufactured by fibroblasts (the fibre-making cells that rebuild all injuries). In smaller cuts, we cannot see the small amount of collagen fibre that forms beneath the surface of skin. However, the large amount of fibre that is needed to close a large wound creates a visible scar. Because scar tissue is made of fibres, not regular skin cells, it is stronger than ordinary skin and may look shiny, with a colour different from the non-injured skin (usually pink or red). As well as being a different colour, some burn scars are itchy and may appear lumpy or raised. 

Burn scars can take from up to two years to “mature” or finish changing. The colour of a mature scar is usually close to the skin’s original colour; the scar does not itch and is no longer painful. Skin that is mature is softer and moves more easily than before. With the proper therapy, the burned skin can heal with the least amount of scarring possible.

During healing and in cases where the burn area crosses a joint, physical therapy is necessary to keep or regain movement that may have been lost due to the tightening of the healing skin. Burn patients may need to wear splints to keep their joints in a stretched position to prevent them from tightening.

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Footnote:

*All information on medical treatments on this site is provided as an overview only. For a complete and up-to-date list of side effects, warnings and precautions, read the product’s package insert and consult your doctor or a pharmacist.
**If you are considering an alternative or complementary therapy, discuss it with your doctor first, and always be sure to keep your doctor up to date about any vitamins, supplements, or other forms of alternative treatment you are taking. Like any medication, alternative therapies can interact with other medications/treatments and, in some cases, have side effects of their own. Remember that “natural” does not mean “safe.”

The one symptom that all burns share is swelling, which usually begins to subside in about 48 hours. However, other symptoms can persist longer than two days and vary according to how serious the burn is.

First-degree burns are superficial, considered mild, and have similar characteristics to a sun burn, affecting only the first layer of skin (the epidermis). These burns cause skin redness and pain. They generally heal in 3 to 5 days, although in some cases the redness may last longer. 

Second-degree burns fall into two types:

• Superficial partial-thickness burns, which injure the first and second layers of the skin (epidermis and superficial dermis)
• Partial-thickness burns, which injure deeper skin layers (epidermis and most of dermis, including deep follicular structures).

Unlike first-degree burns, second-degree burns cause blistering or open sores on the skin, are more painful than first-degree burns, and take 10 to 15 days to heal. If you have a second-degree burn, you should see your doctor. Seek immediate medical help if the burn is larger than 2 or 3 cm in diameter or is on the face, hands, feet, genitals, buttocks, or a major joint.

Third-degree burns (full-thickness epidermal and dermal destruction) are more serious than first- and second-degree burns because they extend through all of the skin’s layers. The skin dies, turns white and has no sensation because of damaged nerve endings. A skin graft is necessary to heal the area. People with third-degree burns that cover a large part of the body can go into shock, stop breathing and die. Anyone with suspected third-degree burns needs to be immediately taken to hospital.

Fourth-degree burns (extends through skin, subcutaneous tissue and into underlying muscle and bone). People with widespread fourth-degree burns can die from their injuries. This type of wound leaves the body vulnerable to infections. Reconstructive surgery is needed to repair the burned area.

Important note: Third- and fourth-degree burns, or burns that cover more than 10% of the body, must always be treated at a hospital.