Burns
What Are Burns?
A burn is damage to the skin caused by something hot, such as boiling water, flames, or gas. Even objects only slightly warmer than body temperature, such as a hot water bottle, a disposable heat pack, or a heated toilet seat, can damage the skin if they remain in contact with it for a long time; this is called a low-temperature burn. The word “low-temperature” may give the impression of something cold, but injury from contact with something cold is called frostbite, whereas a low-temperature burn still refers to damage caused by something warmer than the skin.
The Depth of Burns
Burns are classified according to the depth of the damage.
First-degree burn (epidermal burn)
The skin becomes red and stings, with slight swelling. It heals within a few days without leaving a scar.
Second-degree burn (dermal burn)
At first the skin is red and stinging, and within a few hours blisters form or the skin peels. Second-degree burns are further divided into superficial and deep types. Superficial ones involve little damage to the dermis beneath the epidermis, so they heal in about one to two weeks with little or no scarring. Deep ones involve damage reaching the deeper layers of the dermis; they take about three to four weeks to heal and leave scars.
Third-degree burn (subcutaneous burn)
The damage reaches the lowest layer of the skin, or extends below the skin entirely. The skin turns gray, black, or brown, and the pain becomes dulled. Because treatment with topical medications takes a long time for the wound to close, when the affected area is large, a skin graft, surgically taking skin from elsewhere and attaching it, may be performed.
Treatment of Burns
In the case of an airway burn, where gas has been inhaled and the mucous membranes of the throat are also burned, there is a risk of being unable to breathe, so emergency transport to a specialized facility is required. Likewise, when the burned area is extensive, the patient’s overall condition can deteriorate with complications such as kidney failure, so systemic management at a specialized facility is again necessary. What a clinic can handle is localized burns that are not life-threatening. If, during treatment at our clinic, surgery is judged to be necessary, we will refer you to a facility where it can be performed.
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1. Cooling the affected area
If you get a burn, rather than rushing to see a doctor first, cool it with running water. Running water is considered better than ice water or a cold pack. About 15 to 30 minutes is recommended, but if the water is too cold to do this for long in winter, try to cool it for at least about 5 minutes, even in intervals. It is said that you may cool it through your clothing, but since clothing soaked with hot water pressed against the body keeps it in contact with the heat longer than removing it would, if you are at home and can take it off quickly, first remove it and rush to the shower to cool the area. Also, as first aid, if you apply one of the commercially available occlusive wound dressings, the kind that seals the wound and is left on for several days, over a blister, it will tear the blister when it is peeled off at your examination, so please come in without applying one. It is better to protect the area with gauze or the like.
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2. Topical steroids
In the early stage of a burn, topical steroids may be used to reduce inflammation. When there is a large blister, we pierce it with a needle to drain the fluid before applying the medication, but we do not cut the blister away unless there is an infection. We believe that leaving it in place helps the wound heal faster and with less scarring. As a side effect of steroids, particularly when they are applied without washing the area well, a secondary infection, a bacterial infection that makes the wound harder to heal, can occur.
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3. Topical ointments and anti-ulcer agents
Once the inflammation has settled, we stop the topical steroids and apply an ointment to help the wound close, again protecting it with gauze. If the skin has become necrotic, we may apply a topical medication or anti-ulcer agent that dissolves the dead tissue. In some cases, we surgically remove necrotic tissue that is hindering the skin from closing. Topical medications occasionally cause irritation.
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4. Oral antibiotics
When a patient has diabetes and is in poor condition with strong concern about infection, or when an infection appears to have actually developed, oral antibiotics are given. Side effects of antibiotics include nausea, diarrhea, and rash.