Burns and scalds are among the most common household injuries, but there is a lot of misconception on how to treat them, writes Aznim Ruhana Md Yusup
A MAJOR function of our skin is to protect us from injury as well as from pathogenic infections like bacteria and fungus. It is the largest organ in our body and can detect differences in temperature, pressure and texture. But we can damage our skin when we expose it to excessive heat, chemicals, electricity or radiation. A burn is caused by dry heat, while scalds are caused by something wet, such as hot water or steam.
Damage begins when the skin is heated to at least 40ºC. At 44ºC, skin tissue is unable to tolerate the heat and cell protein begins to denature. Temperatures of over 60ºC can cause injuries to blood vessels and immediate cell death.
Wet heat travels more rapidly into tissue than dry heat, and the burn in the skin tissue will continue to spread until the skin temperature falls and remains below 40ºC so it is necessary to cool the skin down after heat-related accidents.
DEGREES OF SEVERITY
Apart from temperature, the severity of burns and scalds also depend on the duration of the exposure and the intensity of the agent that caused the burn. Young children have thinner skins, resulting in more serious injuries.
Hot beverages like tea or coffee that are served at over 60ºC can cause serious injuries. If it’s just a splash and is removed within seconds, the injury may only be superficial. But the longer the skin is exposed to the hot liquid, the more severe the damage.
A burn that affects only the outer layer of the skin is referred to as a first-degree burn. It leaves the skin dry and red, and is probably painful. An example of this is mild sunburn or a hot beverage spill.
A second-degree burn occurs when both the outer epidermis layer and the dermis layer underneath are damaged. The affected area is red and may appear wet and shiny. You also get blisters and it is painful to the touch.
Such injury occurs when there is brief contact with a hot object. Steam and flames may also cause second-degree burns. These types of burns can be treated at home, and the skin may heal in days or weeks.
A third degree burn, however, destroys the entire layer of the skin, including the fat layer under the dermis. It may be caused by very hot liquid, contact with a hot object for an extended period or an electrical source. The injured skin will appear white and charred and there is no pain because the nerve endings have been destroyed.
A fourth-degree burn involves additional damage to the muscle, tendon and bone. These burns require serious hospital care.
COOL IT DOWN
According to Guardian pharmacist Andrew Kong, understanding the types of burn is the key to knowing how it should be treated, and whether the burn victim should go to the emergency room.
“There’s generally no need for people with first and second-degree burns to go to hospital unless there is an infection, increased pain or redness or swelling from the burn wound.”
However, you might want to consider seeing a medical professional if the damaged area is large or if the burn occurs on the face, scalp, major joints or genitals. Severe pain or loss of sensation should also prompt you to seek treatment.
“The first step is to remove the source of the burn,” says Kong. “Then you should hold the burn area under cool tap water — not cold water — for 10 to 15 minutes until the pain subsides. If this is impractical, soak the burn area in cool water or use a cold compress.”
The concern in using cold water, especially if it’s a large, severe burn, is that it might cause the body temperature to drop — hypothermia. Putting ice on the wound is also harmful as it might damage skin tissue, increasing the risk of infection and scarring.
Other types of home remedies include using butter or ointment. But Kong says greasy substances will trap heat and make the burn worse. Toothpaste isn’t a good idea either, as it’s not sterile after it has been unsealed.
POST-BURN
Once the skin has properly cooled down, Kong suggests covering the burn area with a sterile gauze or bandage that is wrapped loosely so as not to put pressure on the skin.
“Bandaging the skin keeps air off the burn, so it’s less painful. It also protects the blistered skin. But don’t use fluffy cotton bandages as the material can shed and get into the wound. And you might want to take some over-the-counter pain reliever after that.”
You can also consider applying soothing lotions like aloe vera to help in the healing process.
“Some people believe that the protein in egg whites can replace the protein lost in the burn,” Kong says. “This is not true. There is also concern that eggs contain bacteria like salmonella so you should not put in on your wound.”
You also shouldn’t break any blisters as this would leave the skin vulnerable to infection. The burn dressing should be changed once a day. A burn wound is likely to get itchy as it heals, but do try to stop yourself from scratching.
AID AT HAND
Meanwhile, a Singapore-based company says its line of patented bandages can cool the skin down muchfaster than water. It’s called Aluminaid Burn Dressing, and it’s constructed with aluminium as a heat sink in the bandage.
The company’s vice president of Sales and Marketing, Jeff Marquass, explains that Aluminaid is the one step before everything else, adding that it is more effective than hydrogel or water in cooling down the skin.
“When you apply it, skin temperature drops by 2 or 3 degrees Celcius and then the pain receptors are turned off. That’s the instant pain relief that you get.”
The bandage doesn’t contain any drug products. The heat sink does all the work by immediately conducting heat out of the wound.
“The body’s natural reaction to burns and heat is to dissipate it through tissue and muscle,” says Marquass. “While it does that, it creates trauma, swelling, redness and other discomfort.”
“But the bandage draws the heat out. So you’re taking the pain away by taking the heat away. This reduces the damage as well as redness and swelling. If applied early enough, there won’t even be swelling or blisters.”
The Aluminaid Burn Dressing is sterile and comes in different shapes and sizes to help with small burns on the fingertips up to second-degree burns on limbs. It’s also flexible and durable enough to be left on the burnt skin for up to 12 hours if required.
How to avoid minor burns at home
TAKING simple precautions around your home can go a long way in preventing burns and scalds.
Pay more attention if you have children or babies — their skin is more sensitive, and they’re curious while not being fully aware of danger. Older folk are also vulnerable because they may not be able to respond as quickly.
l While cooking, ensure the handle of pots and pans are directed away from you. Even if the handles are heat-resistant, there’s a chance you might knock into them, causing the contents to spill.
l Wait for hot oil to cool before transferring it from the frying pan.
l Keep anything that can catch fire such as towels, plastic bags or curtains away from the stove.
l Use oven mitts, towels or potholders when moving hot food. Make sure it’s dry because wet cloth can steam, causing scalds.
l Microwave ovens do not heat food evenly, and microwaved foods and liquids may reach temperatures greater than boiling without the appearance of bubbling. Stir and test the food before eating.
l If you’re cooking outside, create a 1m safe zone around the grill, BBQ or campfire and keep children or pets outside this area.
l Clean your grill after each use. This will remove grease that can start a fire.
l If you use a water heater at home, always keep the tap or shower on the cold setting when not in use to avoid scalding yourself accidentally.
l Place candles in sturdy containers made of metal, glass or ceramic that can’t be knocked down easily. Candles are an obvious fire hazard but the melting wax may also burn your skin.
l When spending time in the sun, apply sunscreen and wear the right clothes and a wide brimmed hat to avoid getting sunburn.
Sources: the US Fire Administration, WebMD.