First aid at home: how to manage burns and scalds

Burns or scalds at home: what to do and what to avoid

Burns or scalds are very common due to the numerous thermal sources within the modern home.

Common causes of burns and scalds at home

• Kitchen oven
• Gas stove
• Heater
• Iron
• Broom/steam cleaner
• Hair dryer
• Hair straightener
• Water heater
• Space heater

By far the most common sources of burns are from: the spillage of boiling water, broth or oil, and the accidental contact with hot pots or handles, the use of lighters, and lighting or extinguishing candles.

​​What happens when the skin comes into contact with a thermal source

As soon as contact between the skin and thermal source has occurred, heat will quickly spread. How far the burn spreads within the layers of the skin depends on how long the contact with the source lasted; the temperature and the nature of the source.

First-degree burn

A first-degree burn or scald only affects the epidermis and causes pain and redness to the affected area, but does not blister.

Second-degree burn

A second-degree burn affects both the epidermis and superficial dermis. It causes swelling, redness and blistering.

Third-degree burn

A third-degree burn that involves all three layers of skin and fatty tissue. The burned area may appear blackened.

Cells and heat

Skin cells can be compared to very small eggs, in that they have an outer wall (the shell), gelatinous content (egg white), and a denser core (the yolk). When the cells are exposed to high temperature, they also behave like eggs and become hardened through coagulation and protein precipitation. Coagulation is irreversible and leads to cell death, meaning the cell will have to be replaced by a new one. When the skin is burnt, the Zone of coagulation refers to the central, white zone where direct contact with the heat source occurred. Surrounding this area is the Zone of stasis, which is redder and is where cells may survive or later die. Finally, the Zone of hyperemia is the peripheral area that is particularly red due to the dilation of blood vessels as a result of inflammation.

What not to do

As soon as a burn occurs at home, the often go-to response is to immediately run cold water over or apply ice to the affected area. However, doing so poses a risk of thermal shock, which occurs when the cells experience a sudden and extreme temperature change. Going from a very high to a very low temperature causes damage to the cells and will cause pain to increase. Instead, as soon as possible after the burn occurs, gradually cool the area by blowing on it or using a fan, which will help to reduce pain. If a burn occurs through a garment, try to remove the fabric as much as possible, including any solid residue that has stuck to the skin, as fabric retains heat.

The many traditional burn treatments

Many store-cupboard ingredients are touted as DIY burn cures. These include olive oil, butter, honey, egg whites, lemons, potatoes, onions or aloe vera. Those who use these “remedies” often swear by their effectiveness, however they are not empirical and are not supported by any scientific data. On the contrary, most data suggests that these remedies will actually worsen the burn. For example, applying fats (oil, butter etc.) to a burn blocks the exudation process, which leads to maceration and increased infection risk. Instead, using vegetables or plant derivatives (potatoes, aloe etc.) exposes the heat-damaged cells to compounds such as starches or anthraquinones that are non-tolerable. In short, these natural remedies often do far more harm than good.

“Anti-burn” creams

There are many popular, commercially available ‘burn creams’ that are recommended for first-aid kits. These contain active ingredients, the efficacy of which is doubtful. What is certain, however, is that these ingredients (e.g. local anesthetic, chlorinated antiseptic, alcohol, and excipients such as vaseline or silicones) are often waterproof or macerators, and are not well “digested” by already-damaged skin tissue. From a dermatological point of view, even creams with helpful actives should not be applied onto a burn. This is because creams contain at least one emulsifier (surfactants), which are molecules that even healthy skin doesn’t usually tolerate, let alone when it is in crisis after a burn. Similarly, antibiotic or cortisone antibiotic creams should also be avoided, especially as the latter contains cortisone which delays healing.

DermaClub recommends… treatment for burns and scalds

In the considerable experience of DermaClub’s dermatologists, PEG Ointment provides the ideal dressing for a burn. This entirely synthetic ointment contains no water, surfactants, emulsifiers or fats, and does not stick to the skin, meaning that burns can be dressed with gauze without causing further irritation. PEG Ointment absorbs exudates to prevent maceration and reduces the risk of secondary infection. Thanks to allantoin, PEG Ointment also accelerates healing and minimizes the scarring that so often accompanies burns. For first degree burns, apply PEG Ointment directly to the burn once a day for three days until new skin has formed to replace that which was burnt. Applying PEG Ointment immediately after the burn occurring will also help to reduce pain and burning. During this phase of new skin forming, avoid wetting the burnt area as much as possible. For second degree burns where blisters are small and intact, apply PEG Ointment directly as for first degree burns. If the blisters are open and have eroded, apply a considerable amount of PEG Ointment onto a cotton gauze (not TNT) to cover the burn area. Secure the dressing with tubular mesh gauze or tape. In cases of deeper or third degree burns, treat the burn in the same way as a second degree burn while awaiting a consultation for the dermatologist to remove dead tissue. After the burn has been repaired, do not expose the affected area to direct sunlight so as not to leave a dark spot on the skin. If the burn is on the face, neck or hands (areas which are often exposed to sunlight), apply the mineral, photo-reflecting Sun Clay to protect the skin in the weeks following the burn and until residual redness has faded. Do not apply sunscreen, which is not well tolerated by inflamed skin. Therefore, the main benefits of PEG Ointment with allantoin when treating burns and scalds are:

• Decreases pain
• Accelerates repair
• Prevents infection
• Improves outcome after repair
• Easy to apply