Clinical Evidence Handbook
A Publication of BMJ Publishing Group
Burns (Minor Thermal)
Am Fam Physician. 2010 Jun 15;81(12):1437-1438.
Superficial burns that affect the epidermis and upper dermis are characterized by redness of the skin that blanches on pressure, pain, and hypersensitivity. The skin blisters within hours and usually heals with minimal scarring within two to three weeks if no infection is present.
Most minor burns occur in the home, with less than 5 percent requiring hospital treatment.
Cooling the burn for 20 to 30 minutes with cold tap water within three hours of the injury reduces pain and wound edema, but prolonged cooling or use of ice water may worsen tissue damage or cause hypothermia.
We do not know whether alginate dressings, antibiotics, chlorhexidine-impregnated paraffin gauze dressing, foam dressing, hydrocolloid dressing, hydrogel dressing, paraffin gauze dressing, polyurethane film, or silicone-coated nylon dressing are effective in treating minor burns.
Topical antibacterial substances, such as chlorhexidine, may be toxic to regenerating epithelial cells, and their use may delay healing in wounds that are not infected.
Silver sulfadiazine cream may prolong healing times and increase pain compared with other treatments.
What are the effects of treatments for minor thermal burns?
Alginate dressing, antibiotics, chlorhexidine-impregnated paraffin gauze dressing, foam dressing, hydrocolloid dressing, hydrogel dressing, paraffin gauze dressing, polyurethane film, silicone-coated nylon dressing
Likely to be ineffective or harmful
Silver sulfadiazine cream
Burn depth is classified as erythema (first degree) involving the epidermis only; superficial partial thickness (second degree) involving the epidermis and upper dermis; deep partial thickness (second degree) involving the epidermis and dermis; and full thickness (third degree) involving the epidermis, dermis, and damage to appendages. This is a review of minor thermal burns—superficial partial-thickness burns that do not involve the hands or face.
Superficial partial-thickness burns are caused by exposure to heat sufficient to cause damage to the epidermis and papillary dermis. They are characterized by pain and hypersensitivity. The skin seems moist and pink or red, and is perfused, as demonstrated by blanching on pressure. The severity of a superficial partial-thickness burn is usually judged by the percentage of total body surface area involved: less than 15 percent for adults and less than 10 percent for children.
Incidence and Prevalence
The incidence of minor thermal burns is difficult to estimate. Generally, less than 5 percent of all burn injuries requiring treatment will necessitate hospital admission. Worldwide estimates of all thermal burn injuries suggest that about 2 million persons are burned, up to 80,000 are hospitalized with burns, and 6,500 die of burn wounds every year.
The pattern of injury varies among different age groups. Men 18 to 25 years of age seem more susceptible to injury, owing to a variety of causes—mainly flame, electrical, and, to a lesser extent, chemicals. Many burn injuries in this age group are caused by the inappropriate use of flammable agents, such as gasoline. However, most burns occur in the home. Thermal burns (particularly scalds) are common among children and older persons. The kitchen is reported to be the most common place of injury for children, as is the bathroom for older persons. Persons with concomitant conditions or complicating factors, such as motor or neurologic impairment, are at greater risk.
Superficial partial-thickness burns blister within hours but heal spontaneously within two to three weeks with minimal hypertrophic scarring if the wound remains free of infection. The capacity to heal is also dependent on health and age, with older persons and those with concomitant medical conditions prone to delayed healing. Cooling the burn, as part of the initial emergency treatment, substantially reduces pain and wound edema if started within three hours of injury. The optimal duration of cooling a wound may vary from 20 to 30 minutes using tap water (at a temperature of 41° F [5° C] to 77° F [25° C]). Use of ice water or prolonged periods of cooling can deepen tissue injury and induce hypothermia, and are best avoided.
Wound-cleaning solutions and dressings aim to prevent infection. The ideal dressing will establish an optimal microenvironment for wound healing. It will maintain the wound temperature and moisture level, permit respiration, allow epithelial migration, and exclude environmental bacteria.
Adapted with permission from Wasiak J, Cleland H. Burns (minor thermal). Clin Evid Handbook. December 2009:654–655. Please visit http://www.clinicalevidence.bmj.com for full text and references.
This is one in a series of chapters excerpted from the Clinical Evidence Handbook, published by the BMJ Publishing Group, London, U.K. The medical information contained herein is the most accurate available at the date of publication. More updated and comprehensive information on this topic may be available in future print editions of the Clinical Evidence Handbook, as well as online at http://www.clinicalevidence.bmj.com (subscription required). Those who receive a complimentary print copy of the Clinical Evidence Handbook from United Health Foundation can gain complimentary online access by registering on the Web site using the ISBN number of their book.
A collection of Clinical Evidence Handbook published in AFP is available at http://www.aafp.org/afp/bmj.
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