Introduction:

Burns can happen when the skin is exposed to heat (from fire or hot liquids), electricity, corrosive chemicals, or radiation (UV rays from the sun or tanning beds, or radiation treatments). Burns are classified as follows, according to the severity of tissue damage:

• First degree burns -- affect only the outer layer of the skin (epidermis), causing pain and redness.
• Second degree burns -- extend to the second layer of the skin (the dermis), causing pain, redness, and blisters that may ooze. Deep second degree burns may progress to third degree burns over the course of several days.
• Third degree burns -- involve both layers of the skin and may also damage the underlying bones, muscles, and tendons. The burn site appears pale, charred, or leathery. There is generally no pain in the area because the nerve endings are destroyed.
• Fourth degree burns -- extend through the skin and subcutaneous fat into the underlying muscle and bone. Fourth degree burns are stiff and charred.

Between 1 - 2 million Americans seek medical attention for burns each year. Most burns occur at home, at work, or are part of an injury from a motor vehicle accident. Between 50,000 - 70,000 people are hospitalized for burns every year in the United States, 30 - 40% of whom are children younger than 15 years of age. Most burns in children come from scalding liquids. All burns -- even minor ones -- may cause complications if not properly treated. Skin is the body's natural barrier to infection, and burns destroy that protection, so treatment usually involves preventing or treating infections.

Signs and Symptoms:

Signs and symptoms of burns are different depending on how severe the burn is (as described above). Your doctor will evaluate the extent of the burn (the amount of skin or body surface area that the burn covers) to assess the risk for complications, such as infection, dehydration, and disfigurement.

Infection

People who get burned are very prone to infection. It can be hard to tell if a minor burn is infected because the skin surrounding a burn is usually red and may become warm to the touch -- both of which are also signs of infection. Any change in the appearance of a burn, or in the way that the person feels, should be brought to the attention of a doctor. Potential signs of infection include:

• Change in color of the burnt area or surrounding skin
• Purplish discoloration, particularly if swelling is also present
• Change in thickness of the burn (the burn suddenly extends deep into the skin)
• Greenish discharge or pus
• Fever

Dehydration

In severe or widespread burns, fluid is lost through the skin, and the person can become dehydrated. Dehydration can lead to life threatening shock. A doctor will treat dehydration with intravenous (IV) fluids. Potential signs of dehydration include:

• Thirst
• Lightheadedness or dizziness, particularly when moving from sitting or lying position to standing
• Weakness
• Dry skin
• Urinating less often than usual

Burn Patterns

Burns have typical and atypical patterns. Typical patterns result from accidental burns while atypical patterns may be a sign of physical abuse. Typical burns (from spilling hot liquid, for example) tend to occur in exposed areas such as the arms, face, and neck. Atypical burns may occur in unexposed areas such as the buttocks. Burns involving entire hands and feet are also not typical, nor are third degree burns involving a very small, focused area (resembling, for example, a cigarette).

Causes:

Burns are caused by exposure to thermal (heat), electrical, radiation, or chemical sources. Thermal burns occur when hot metals, scalding liquids, steam, or flames come in contact with the skin. Exposure to electrical current causes electrical burns, and contact with caustic chemicals causes chemical burns. Prolonged exposure to the sun's ultraviolet rays or to other sources of radiation (such as from tanning booths) can also cause burns.

The most serious burns are usually caused by scalding hot or flammable liquids, and fires. Exposure to chemicals and electrical currents also cause severe injury and damage to the skin.

Risk Factors:

Risk factors for burns include:

• Wood stoves, exposed heating sources, or electrical cords
• Unsafe storage of flammable or caustic materials
• Careless smoking
• Child abuse
• Hot water heater set above 130 °F
• Heated foods and containers
• Too much exposure to the sun

Preventive Care:

These actions can reduce your risk for burns:

• Installing smoke detectors
• Teaching children about fire and burn prevention in schools
• Stopping smoking and heavy alcohol use
• Wearing flame retardant clothes (particularly children)
• Planning emergency exit routes in the home, school, and workplace
• Practicing fire drills

These steps may help reduce the severity of a burn once it occurs:

• Giving first aid immediately
• Getting prompt medical attention
• If hospitalization is necessary, being treated by a dedicated burn unit with staff specially trained in burn care

Diagnosis:

When diagnosing a burn, a doctor evaluates the depth and extent of the damage, the degree of pain, the amount of swelling, and signs of infection. Doctors classify the burn based on the depth and extent of the injury. Burns that cover a significant portion of the body, burns associated with smoke inhalation, burns from electrical injuries, and burns associated with suspected physical abuse require immediate emergency medical attention. In the emergency room, all wounds are wrapped with sterile cloths. Patients may receive oxygen (either through a mask or tube) and fluids. Patients are also evaluated for associated injuries (such as from physical abuse). Doctors may also conduct tests to determine whether the wound is infected.

Treatment:

While minor burns may be treated at home, all other burns require immediate emergency medical attention because of the risk of infection, dehydration, and other potentially serious complications.

These are first aid steps for burns:

First degree burns:

• Run cool water on burned area for 5 - 10 minutes or cover the area with a cool compress.
• Don't apply oil, butter, or ice to the burn.
• Take ibuprofen or acetaminophen to relieve pain and swelling.
• Any burn to the eye requires immediate emergency help.
• Do not use burn care or other ointments for 24 hours to avoid sealing in the burn.

Second degree burns:

• Do not break blisters.
• Do not remove clothing that is stuck to the skin.
• Run cool water on burned area for 5 - 10 minutes, or cover the area with a cool compress then carefully remove clothing that is not stuck to the skin.
• Elevate burned area above the heart.
• Take ibuprofen or acetaminophen to relieve pain and swelling.
• If not near a medical facility, apply bacitracin ointment or honey on broken blisters to prevent infection (this is the only situation in which bacitracin or honey should be applied to burned skin).
• If the burn is near the mouth, nose, or eye, seek emergency medical help immediately.

Third degree burns:

• If the person is on fire, have them stop, drop, and roll.
• Call 911.
• Check airway, breathing, and circulation.
• Do not remove clothing that is stuck to the skin.
• Run cool water continuously on burned area. Do not immerse large burn areas in water.
• Elevate burned area above the heart.
• Cover the burned area with a sterile bandage or a clean sheet. Do not apply any ointments.

People who are burned seriously will be admitted to a hospital. There, doctors will concentrate on keeping the burned area clean and removing any dead tissue through a process called debridement. Medications will be used to reduce pain and prevent infection. A tetanus shot will be given if the person has not had one in 5 or more years.

Burns often cause pain and anxiety, even during recovery. A person may also experience emotional distress if a burn changes his or her appearance. Complementary therapies that may help alleviate such pain and anxiety include:

• Massage therapy
• Hypnosis
• Therapeutic touch
• Acupuncture

Good nutrition is important as people recover, because vitamins and minerals have been shown to promote wound healing and prevent the spread of infection.

Fourth degree burns require the same attention as third degree burns. Patients should seek medical help immediately.

Medications

• Antimicrobial ointments (such as silver sulfadiazine, mafenide, silver nitrate, and povidone-iodine) are used to reduce risk of infection. Bacitracin may be used for first degree burns. One study found that parrafin gauzes are valuable for superficial burns while silver based dressings are preferable for deep burns.
• Antibiotics (such as oxacillin, mezlocillin, and gentamicin) are used to treat infection. Antibiotics will also probably be used if the risk of developing infection is high (for example, when the body surface area of the burn is large).
• Prescription pain medications (such as acetaminophen with codeine, morphine, or meperidine) are used for severe burns.
• Anabolic steroids, such as oxandrolone, may be used for severe burns to help decrease wound healing time.

Surgery and Other Procedures

In the case of severe burns, debridement and skin grafting may be performed. Debridement is the removal of dead tissue. In skin grafting, a piece of skin is surgically sewn over the burn, after any dead tissue is removed. The skin can be from another part of the person's body, from a donor, or from an animal (usually a pig). Skin grafts from the person's own body are permanent. Artificial skin may also be used. Cosmetic surgery may be done to improve both the function and appearance of the burned area.

Nutrition and Dietary Supplements

Minor burns can be treated with natural products. Severe burns, however, always require immediate medical attention. It is especially important for people who have been seriously burned to get enough nutrients in their daily diet. Burn patients in hospitals are often given high calorie, high protein diets to speed recovery.

Do not try to treat a second or third degree burn by yourself. Always seek medical advice. Ask your doctor which supplements are best for you. Always tell your health care provider about the herbs and supplements you are using or considering using, as some supplements may interfere with conventional treatments.

Following these tips may improve your healing and general health.

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers). One study found that high doses of vitamin C post burn reduced fluid requirements by 40%, reduced burn tissue water content 50%, and reduced ventilator days.
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold water fish, tofu (soy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.

The following supplements may also help. Be sure to ask your doctor before taking them if your burns are moderate or severe:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tablespoonful oil, 1 - 2 times daily, to help decrease inflammation, and for healing and immunity. Cold water fish, such as salmon or halibut, are good sources, but you may need a supplement to get a higher dose. Omega-3 fatty acids can interact with blood thinning medications such as Coumadin (Warfarin) and aspirin.
• Vitamin C (1,000 mg 2 - 6 times per day) helps skin heal by enhancing new tissue growth and strength. Lower dose if diarrhea develops. Vitamin C should be used only under a physician's guidance in patients with cancer, certain blood iron disorders, kidney stones, diabetes, and a metabolic deficiency called "glucose 6 phosphate dehydrogenase deficiency" (G6PDD).
• Vitamin E (400 - 800 IU a day) promotes healing. May be used topically once the burn has healed and new skin has formed. Higher doses may help in healing burns. Talk to your doctor before taking vitamin E if you are scheduled to have surgery. Vitamin E can interact with certain medications, including, but not limited to antiplatelet / anticoagulant drugs. Speak with your doctor.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity. Coenzyme Q10 may have a blood clotting effect and can interact with blood thinning medications (anticoagulant / antiplatelet drugs).
• L-glutamine, 500 - 1,000 mg 3 times daily, for support of gastrointestinal health and immunity. Glutamine in high doses can effect mood particularly in patients with mania. There is some concern that people who are sensitive to MSG (monosodium glutamate) may also be sensitive to Glutamine. Patients with hepatic encephalopathy, severe liver disease with confusion, should not take Glutamine.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day. Taking antibiotics can upset the balance of bacteria in your intestines. Probiotics or "friendly" bacteria can help restore the balance, improving gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.

Herbs

Minor burns may be treated with herbs, but you should never take or apply any herb when you have moderate o severe burns. Call for emergency help first.

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

These herbs may be applied topically (externally) to minor burns:

• Aloe (Aloe vera), as a cream or gel. Apply externally to the burned area, 3 - 4 times daily as needed, for soothing and healing.
• Calendula (Calendula officinalis), or pot marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. You can also steep 1 tsp. of flowers in one cup of boiling water for 15 minutes, then strain and cool. Test skin first for any allergic reaction.
• Gotu kola (Centella asiatica) as a cream containing 1% of the herb, may help repair skin tissue.
• Propolis, a resin created by bees to build their hives, has been used historically to treat skin wounds. One study found that people given propolis to apply to minor burns healed as well as those treated with silver sulfadiazine, a prescription ointment. More research is needed, however. If you use propolis for a minor burn, test skin first for any reaction.

Acupuncture

Electrical Stimulation

Transcutaneous electrical nerve stimulation (TENS) uses controlled, low voltage electrical stimulation of the skin to relieve pain. Recent studies have suggested that TENS applied to acupuncture points (called electroacupuncture) on the ear (auricular acupuncture) may relieve pain for people with burns.

Massage and Physical Therapy

Massage Therapy

People with burns suffer pain, itching, and anxiety both from the burn itself and during the healing of wounds. Some studies suggest that massage may help ease these symptoms in both the emergency care and recovery phases. People receiving a massage reported significantly less itching, pain, anxiety, and depressed mood compared to those who received standard care only. Ask your doctor before using massage after a burn.

Physical Therapy

Occupational and physical therapy begin very early for people who are hospitalized for burns. Occupational and physical therapists use a number of techniques to improve movement and function of the areas affected by a burn, and to reduce scar formation. Physical therapy may include the practices listed below:

• Body and limb positioning
• Splinting
• Help with activities of daily living until normal function and ability are recovered
• Passive (physical therapist moves the person's limbs) and active exercises
• Help with walking

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies in the treatment of burns, professional homeopaths may consider the following measures to treat first and second degree burns and to aid recovery from any burn. Before prescribing a remedy, homeopaths take into account a person' s constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

• Place the burned area in cold water until the pain goes away (this generally takes at least a few minutes).
• Arnica Montana -- taken orally immediately after the burn.
• Calendula -- apply to the skin for first degree burns and sunburns. This remedy is sometimes considered the treatment of choice for children. Calendula may also be used in the healing stages of second and third degree burns to stimulate regrowth of skin and to decrease scar formation.
• Hypericum perforatum -- used on the skin if there are sharp, shooting pains with the burn.
• Urtica urens -- taken orally for stinging pains, itching, and swelling of first degree burns. A cream or gel may also be applied to the skin for first degree burns and sunburns. This remedy may be used for children.
• Causticum -- taken orally for burning pains with great rawness (as from an open wound) or when there are long term physical or emotional symptoms after a burn.
• Phosphorus -- taken by mouth for electrical burns, especially if the individual is easily startled and excitable.

Mind-Body Medicine

Hypnosis

Several studies suggest that hypnosis may reduce pain and anxiety and enhance relaxation in people with burns.

Therapeutic Touch

Therapeutic touch (TT) is based on the theory that the body, mind, and emotions form a complex energy field. Therapists seek to correct the body's imbalances by moving their hands just over the body, what they call "the laying on of hands." This practice has been used for a number of conditions including pain and anxiety, but studies have shown conflicting results. One study of patients hospitalized for severe burns suggests that TT may reduce pain and anxiety associated with burns.

Other Considerations:

Prognosis and Complications

• Infection is the most common complication of burns and is the major cause of death in burn victims. More than 10,000 Americans die every year from infections caused by burns.
• Compromised immune system
• Functional or cosmetic damage (reconstructive surgery may be necessary)
• Increased risk of developing cancer at the burn site
• Carbon monoxide poisoning (in the case of a fire)
• Heart attack which may be severe enough to cause the heart to stop (called cardiopulmonary arrest)
• Adrenal insufficiency

First degree burns generally heal on their own in 10 - 20 days if no infection develops. In rare cases, first degree burns spread more deeply to become second degree (this spread is caused by infection). Deep second degree burns may progress to third degree. Third degree burns may require a skin graft.