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Treating Burns

Unfortunately the groundhog saw his shadow again this year, so time to buckle down for a few more weeks of winter. Fireplaces and wood stoves feel great on cold winter nights but can lead to painful burns. Burns vary in type and severity. How do you know if it is bad enough to go to the doctor? What do you do immediately when you get a burn?

What types of burns are there?
Burns used to be classified by degree (1st, 2nd, 3rd, 4th) but now are classified by partial versus full thickness. The most common is a superficial (1st degree) burn. With these burns, the skin is red and painful but the area blanches (turns white) when you apply pressure and they resolve without treatment within 3 to 6 days. An example would be a typical sunburn.

The next burn is a superficial partial-thickness burn (2nd degree). These burns typically are red and often have blisters. They are painful and sometimes require treatment. These can take up to three weeks to heal and sometimes leave minor scars such as skin color changes.

Deep partial-thickness burns (3rd degree) are more severe. They penetrate fully into the top two layers of skin. These burns are typically only painful when you push on them rather than just being exposed to the air. They always are associated with blisters of some type but the skin does not blanch. You should seek care with your primary care provider for any burns with symptoms like this.

Lastly, full thickness (4th degree) burns indicate damage to all the layers of the skin and may even include damage to the fat and muscle underneath. These burns require emergency care and if they cover a large portion of your body surface area, they may be life threatening. If you have a full thickness burn, seek care from your doctor immediately.

When do I need to see my doctor?
Any deep partial-thickness burns or full-thickness burns need to be evaluated by a medical provider. If you do not know if your burn falls into one of these categories, make an appointment to have it evaluated. Also, any burns involving the face, genitals, hands or feet need evaluated. All circumferential burns (going all the way around the body such as in a band-like fashion around the arm or leg) need attention as they may cause damage by squeezing the underlying tissue. If greater than 5% of your body surface area is affected by anything other than a superficial burn, such as mild sunburn, you need an appointment. Also, burns greater than 3 inches across or that go deep into the skin are concerning.

If your skin shows any sign of infection or you run a fever greater than 100.4 after you have been moved to an air conditioned or shaded area, this is an indication to see a provider. Also, anyone under the age of 5 or over the age of 70 as well as any individual who is at high risk for infection needs to have the area evaluated. If you are not up to date on your tetanus shot, you need to get one for a burn even if it didn't occur outdoors.

What can I do to treat it?
The best thing you can do for any burn is to get it cooled off and away from the offending material as quickly as possible. Longer exposure means more severe damage. Wash the area with cool water and gentle antibacterial soap. Do not apply lotions or creams for the first 24 hours. These may not allow the heat to leave the area and lengthen the healing time. If clothes or bandages stick to the wound or if you don't feel any pain in the area, that is an indication to get the burn evaluated as soon as possible.

If you ever have a concern about a burn and whether or not it is severe, it is always best to have it evaluated by a medical professional. Long-term outcomes are better when proper treatment is initiated immediately. When in doubt, call your doctor. Most importantly, play it safe around fireplaces, wood stoves and any other source of heat this time of year. Also make sure when possible that children are kept out of reach of hot objects. Keep safe and remember, it's only 6 more weeks until spring!

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