Save your skin: what you need to know about burns, scarring and body piercing

"Every year thousands of children are admitted to hospital with burns sending a clear message to parents to be vigilant and keep hot liquids, heating devices and very hot meals out of a child's way. Many young males receive burns at work highlighting the impo rtance of stringent occupational safety initiatives. MBF encourages everyone to make sure they know how to apply first aid to someone who has received a burn as first aid can have a significant and positive impact on a patient's outcome." MBF's Chief Medical Officer, Dr Christine Bennett.

What is a burn?

Burns occur when heat, radiation or chemicals damage the skin, underlying tissues, or even internal tissues. They can be serious injuries that require urgent medical attention and specialised care. ¹

The categories of burns and their treatment very much depend on the depth, area and location of the burn. Burn depth is generally categorised as first, second or third degree. A first degree, or superficial, burn is similar to a typical sunburn. The skin is red and usually painful. Second degree -- or partial thickness -- burns are also red but damage is now severe enough to cause peeling or blistering of the skin and the pain is usually more intense. In third degree -- or full thickness burns -- the damage results in death of the skin and can involve damage to underlying tissues. The skin appears white and without sensation. Third degree burns are the ones most difficult to treat and sometimes require skin grafting.

All burns result in fluid accumulation and an inflammatory response in and around the wound. The skin is the body's first line of defence against infection, so damage can expose you to infection at the site of the wound as well as internally.

What causes a burn?

Exposure to flames, radiation (most commonly the UV radiation from the sun), hot liquids, electricity (including lightning) and some chemicals can cause burns.

Why is it important?

The severity of a burn and the speed at which medical attention is received can dramatically impact the outcome. Administration of first aid can limit the extent of injury and may be able to prevent scarring or more serious life threatening complications.

General Statistics

Approximately 46, 600 people were hospitalised in Australia as a result of burn or scald-related injury from 2000 to 2004. 61% of these admissions were male.
Injuries resulting from burn and scald injuries were especially high for young children aged four years and under, with 12,159 children hospitalised during the period 2000 to 2004.
For infants aged one year or less, 84% of the burns and scalds injuries occurred between the ages 7-12 months.
Males accounted for 88% of injuries resulting from exposure to a highly flammable liquid (e.g. petrol) requiring hospitalisation.
For males aged 15 to 39, 22% of burn and scald injuries were sustained at work.
Scald injuries are common in older people with the rates of hospitalised scalds -- those involving hot tap water and other fluids -- rising with age after around 70 years. This type of injury represents 24% of burn hospitalisations for those aged 70 to 74, and increases to 40% in those aged 85 and over.
Most burns on patients admitted to hospital are not in the very severe category. 24% are for full thickness burns, with 96% of those affecting a body surface area of less than 10%. However, all burns can be serious and require treatment. ²

Who is most at risk?

Young children - from hot liquids / scalds: a clear reminder of the need for parental vigilance and keeping children out of range of hot liquids, heating devices and very hot meals
Males in their late teens to early twenties - from highly flammable liquids in the workplace: occupational safety initiatives remain an important opportunity to avoid these injuries
Older people - from hot tap water

How should I treat a burn? (Source: McComb Foundation)

Check for danger and call for help: watch for hazards such as electrical wires before helping the patient
If there are direct flames, stop the burning: stop, drop (the person to the floor) and roll - remove the burning source or move the patient ie remove the source of the heat, burning clothing, jewellery, etc.
ABCs: monitor airway, breathing, circulation for serious and extensive burns. Call 000 if patient is unwell.
For most burns, cool the burn for 20 minutes: this step is very important. Never use ice, oils or creams. Clean cool running water between 5-25 degrees is best. Although it might feel uncomfortable, the reduction in damage might save someone from much worse discomfort later. Continuously wet towels and burn specific dressings can also be useful. Lakes, oceans, rivers and swimming pools can also help but the risk of infection from open water sources is greater. Use if nothing else is available.
Never use ice or icy water as it can cause further injury.
For chemical burns, irrigate with water. If possible, take the bottle or label to the hospital.
For a serious burn that you are taking to seek medical attention, cover the wound: wet, clean cotton dressings and burns specific dressings are good alternatives.
Avoid hypothermia (that is, be careful that if the wounds are extensive, that the patient isn't being "overcooled" in your efforts to keep the burn comfortable): cool the wound but keep the patient warm.
Seek medical aid urgently for any but minor burns.

Before going out in the sun, don't forget to slip on a shirt, slop on some sunscreen, slap on a hat and wrap on a pair of sunnies.

What is happening with burns technology today?

Burns care is rapidly evolving, with continuous improvement in critical care, nutrition, pain management, surgery and wound care. Survival from even severe injury is now more common, and improving the outcome for survivors is the main focus of research organisations such as Dr Fiona Wood's McComb Research Foundation, which also receives funding from the MBF Foundation.

Even with these advances, it is still difficult to assess what treatments provide the most benefit to patients. The Burns Clinical Outcome Research Project (BCORP) is helping to address this problem, establishing a new set of standards to measure treatment success in burns. Other research is focussing on physiotherapy, nutrition, artificial skin substitutes and surgical intervention of serious burn patients.

What is scarring?

In humans, when the skin is damaged by surgery, infection, trauma, heat or radiation, the initial reaction of the tissue is inflammation. The skin needs to seal off any broken blood vessels so a plug forms, which then dries to become a scab. The scab protects the skin while the healing process takes place underneath and new layers of skin develop.

Depending on the amount of damage, the tissue may be completely restored to normal, or scar tissue may form over the healed wound or cut. If the scarring is significant, which is more likely for second and third degree burns, loss of function, chronic pain or disfigurement can result if the damage has been severe. ³

Occasionally when the skin is healing, more tissue forms than is required and the scar becomes thick and raised. This is known as a keloid scar. Keloid scarring is localised abnormal thickening of the skin that usually forms after a wound or laceration has healed. ⁴

Keloid scars can be unsightly and they may be tender, painful, itchy or produce a burning sensation. ⁴

If you are known to be prone to keloid scarring, your dermatologist may recommend either treatment with a steroid cream once initial healing has commenced and the wound or burn has been covered with a layer of protective skin, or may even advise you to have an injection of steroid into the wound to reduce the likelihood of keloid forming.

General Statistics on Keloid

All races may be affected but some races may be genetically predisposed
It is more common in Chinese and Polynesian people but the highest incidence is among those whose racial origin is sub-Sahara Africa.

Body piercing

The most important thing to remember if you want to have your body pierced is to prevent infection. The skin to be pierced must be clean and free from infection.

Instruments used for body piercing can be contaminated with blood if they are not properly cleaned and sterilised between clients. It is preferable that the cutting part of any instrument that has come in contact with blood is disposed of and a new one used for each person. Surgical steel and gold are the best metals for jewellery as they can be more easily sterilised. ⁵

If an individual has a predisposition to keloid formation, it is important to look to prevention for the future. Those who have keloids only on the earlobes are not necessarily at risk however it is a reminder to avoid body piercing and to follow doctors' recommendations in relation to essential surgery. ⁴

About the McComb Research Foundation

The McComb Research Foundation is a not-for-profit organisation established by former Australia of the Year Dr Fiona Wood. The McComb Foundation is dedicated to a service of excellence to survivors of burn injury, trauma and others who will benefit from tissue engineering using skin culture techniques.

The MBF Foundation supports Dr Wood's effort to achieve scarless healing.

Sources:

¹ McComb Foundation

² 2006 Australian Government report on Burns and Scalds: http://www.nisu.flinders.edu.au/pubs/reports/2006/injcat92.pdf

³ St Vincents Hospital

⁴ www.patient.co.uk

⁵ Better Health Channel, Victorian Government

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