Progress in treating burns

FDA Consumer, Feb, 1985 by Annabel Hecht

As long as there has been fire, people have managed to burn themselves. Every year more than 2.4 million Americans suffer burns. Fortunately, most burns are minor and can be treated at home, in a doctor's office, or hospital emergency room. But about 5 percent of burn injuries (120,000 annually) are severe enough to require hospitalization. Deaths from burns total some 12,000 each year.

Like other accidents, most burn injuries occur at home. Nearly 90 percent of the burn injuries that occur at home are caused by scalds, contact with a hot object such as an iron or a stove, or clothing that has caught on fire. About two-thirds of these burns involve the hands and arms while most of the rest are on the face and legs. Outside the home, the most common burn injury is that summer bugaboo sunburn, which probably predates even fire. Of more recent vintage are workplace burns caused by chemicals and electricity.

All burns, regardless of size, damage the skin, an effect that is usually visible. Even in the smallest burn--from a hot iron or a spatter of grease, for instance--the injured skin first becomes red, then turns brown. Burns also damage the capillaries to widen and fluids leak out of them more easily, resulting in a weepy appearance in more severe burns and a swelling of tissues around the burn. What is not visible is the injury burns cause to the body's immune system, making the victim more likely to develop infections.

How a burn is treated depends on how serious it is. One measure of severity is the percentage of the body that has been burned, usually estimated by what is called the "Rule of Nines." Under this system, the body is divided into 11 areas, each representing 9 percent or multiples of 9 percent of the total. An area equivalent to one side of the hand is about 1 percent of the body surface of an adult.

The Rule of Nines has to be modified for children under 10 since their bodies have different proportions than adults. A child's head, for example, is larger in relation to the rest of the body than an adult's.

Another measurement of burn severity is the depth of the injury, described by the familiar terms "first," "second," "third," and "fourth" degree burns (see Table 1).

First aid for small first degree burns is relatively simple. Nothing other than cool water may be needed. (Never mind what Aunt May said about using butter on a burn. The salt in the butter could make matters worse if the skin is broken.) Scientific studies have shown that cool water retards inflammation, blistering and tissue damage by reducing the heat of the burn. The burn should be kept in still (not running) water until the pain stops. Ice is not recommended. It may cause frostbite or other damage to the burned area.

In the majority of superficial burn cases, no further treatment is necessary, and the burn will heal by itsself. If there is pain and discomfort it may be relieved by a number of nonprescription, or over-the-counter (OTC), topical drug products with ingredients such as benzocaine, menthol and diphenhydramine hydrochloride.

Skin protectants such as cocoa butter and petroleum jelly (e.g., Vaseline) may be used to cover the burn and protect it from the air. Topical antibiotics such as chortetracycline hydrochloride and bacitracin may help prevent infection.

A complete list of OTC ingredients FDA considers safe and effective for the treatment of minor burns is given in Table 2.

A superficial burn that does not heal after seven days of self-treatment should be examinted by a doctor. Any burn that is serious enough for a trip to the doctor should not be covered with medication. It probably would have to be removed during the doctor's examination, and the removal could be painful.

More severe burns require immediate medical attention. Not all will require hospitalization, however. Moderate and uncomplication burns usually can be taken care of in the doctor's office or hospital emergency room. They are generally treated first by cleansing with soap and water and rinsing with a saline solution. Fluid is removed from unbroken blisters and the skin is left in place to provide a natural cover over the burn. Burns on the hands, legs, face, neck and thigh area are often left uncovered. This form of open treatment allows the would to dry and prevents joint stiffness.

When closed treatment is necessary, however, the burn is covered with sterile, fine-mesh absorbent gauze impregnated with sterile petroleum jelly. Additional layers of gauze are piled on top and the whole is covered with a firmly applied bandage. To prevent infection, or fight it if it's already developed, prescription drugs such as 0.5 percent silver nitrate solution, mafenide or gentamicin ointment, or 1 percent silver sulfadiazine cream may be applied to the burn area before the wound is covered.

After about the third day, the wound can be soaked in water or a saline solution to help reduce inflammation.

Hospitalization is a must for all major burns. These include second degree burns involving more than 25 percent of the adult body surface (20 percent in children), third degree burns involving more than 10 percent of the body, and third degree burns on the hands, face or thigh area. Very young and very old patients should be treated in the hospital even when they have burns of lesser severity. The risk of death for any burn patient goes up in proportion to the total skin loss, and that risk is even greater for patients at the two ends of the age scale.