Superficial Burns

Introduction | Aetiology and Risk Factors | Clinical Presentation | Diagnosis | Management and Treatment | Prevention | When to Refer | References

Introduction

Superficial burns, also known as first-degree burns, are injuries that affect only the outermost layer of the skin, the epidermis. These burns are typically caused by brief exposure to heat, sunlight, or certain chemicals. While they can be painful, superficial burns usually heal without significant medical intervention and rarely result in scarring. Proper initial care is essential to manage pain and prevent complications.

Aetiology and Risk Factors

Superficial burns can result from various causes, often related to brief exposures to heat or other irritants:

• Thermal Burns: Caused by brief contact with hot objects, liquids (scalds), or flames.
• Sunburn: Resulting from overexposure to ultraviolet (UV) rays, typically from the sun or tanning beds.
• Chemical Burns: Caused by exposure to irritant chemicals, usually acids or alkalis, that damage the skin.
• Radiation Burns: Occur from brief exposure to radiation sources, such as in radiotherapy or industrial settings.
• Friction Burns: Result from skin rubbing against a rough surface, generating heat and causing superficial damage.
• Electrical Burns: Low-voltage electrical injuries can cause superficial burns at the entry and exit points.
• Risk Factors: Certain factors increase the risk of superficial burns, including lack of protective equipment, alcohol consumption (leading to accidents), and certain occupations or recreational activities.

Clinical Presentation

The presentation of superficial burns is typically straightforward, with the following signs and symptoms:

• Redness (Erythema): The affected area appears red and inflamed due to increased blood flow.
• Pain: Superficial burns are often painful, as the nerve endings in the epidermis remain intact.
• Swelling: Mild swelling may occur in the affected area.
• Dry Skin: The skin may appear dry and peeling, especially as the burn begins to heal.
• Absence of Blisters: Unlike deeper burns, superficial burns do not typically cause blistering.
• Healing: These burns usually heal within 7-10 days without scarring, though some temporary discolouration may persist.

Diagnosis

The diagnosis of a superficial burn is primarily clinical, based on the appearance of the burn and the history of exposure:

• History: Obtain a detailed history of the incident, including the source of the burn, duration of exposure, and any first aid measures taken.
• Physical Examination: Inspect the burn for characteristic features such as redness, pain, and absence of blisters. Assess the burn's size and location to determine the extent of injury.
• Assessing Burn Depth: Confirm that the burn is superficial and does not involve deeper layers of the skin.
• Differential Diagnosis: Consider other causes of erythema and pain, such as cellulitis, contact dermatitis, sunburn, photodermatitis, or erythema ab igne, particularly if the history is unclear or the presentation is atypical.
• Documentation: Record the percentage of total body surface area (%TBSA) affected, even though superficial burns are not included in formal %TBSA calculations for severe burns.

Management and Treatment

Management of superficial burns focuses on pain relief, preventing infection, and promoting healing:

1. Immediate First Aid

• Cooling: Immediately cool the burn with cool (not cold) running water for 20 minutes to reduce pain and limit tissue damage. This is effective up to 3 hours after the injury.
• Avoid Ice: Do not use ice or iced water, as extreme cold can cause vasoconstriction and further tissue damage.
• Remove Constricting Items: Gently remove any jewellery or tight clothing from the affected area before swelling develops.
• Avoid Home Remedies: Do not apply butter, oils, toothpaste, or other home remedies to the burn, as these can trap heat and increase the risk of infection.

2. Pain Management

• Oral Analgesics: Over-the-counter pain relievers such as paracetamol or ibuprofen can help manage pain and reduce inflammation.
• Topical Anaesthetics: Products containing lidocaine may provide temporary pain relief but should be used with caution and under guidance.

3. Wound Care

• Cleaning: Gently clean the burn with mild soap and water to remove any debris or contaminants.
• Moisturising: Apply a moisturising lotion or aloe vera gel to keep the skin hydrated and soothe irritation.
• Dressings: Superficial burns usually do not require dressings, but a non-stick, breathable dressing may be used if the burn is in an area prone to friction or if there is concern about contamination.
• Avoid Popping Blisters: If small blisters develop, do not intentionally burst them, as this can increase infection risk.

4. Infection Prevention

• Topical Antibiotics: While not routinely required, a topical antibiotic ointment such as silver sulfadiazine may be used if there is a risk of infection, particularly in immunocompromised patients.
• Monitoring: Monitor the burn for signs of infection, such as increased redness, warmth, swelling, or pus. Seek medical attention if these symptoms occur.

5. Sun Protection

• Advise patients to protect the burned area from sun exposure until fully healed, as the new skin is more susceptible to sunburn and hyperpigmentation.
• Use sunscreen with high SPF and wear protective clothing over the affected area.

6. Patient Education

• Home Care Instructions: Provide guidance on how to care for the burn at home, including hygiene, monitoring for signs of infection, and when to seek further medical attention.
• Avoiding Re-injury: Advise on how to prevent re-injury to the healing skin, including avoiding friction and protecting the area during activities.
• Hydration and Nutrition: Encourage adequate fluid intake and a balanced diet to support the healing process.

7. Alternative and Complementary Therapies

• Aloe Vera: Discuss the use of aloe vera gel for its soothing properties, ensuring that products used are pure and free from additives that may irritate the skin.
• Honey: While honey has antimicrobial properties, its use should be guided by medical advice, especially in burns.
• Herbal Remedies: Caution patients about using herbal remedies without consulting a healthcare professional.

Prevention

Preventive measures can help reduce the risk of superficial burns:

• Safe Handling of Heat Sources: Exercise caution when handling hot objects, liquids, or open flames. Use protective gloves and equipment when necessary.
• Sun Protection: Use sunscreen with a high SPF, wear protective clothing, and avoid excessive sun exposure, particularly during peak hours.
• Proper Chemical Use: Follow safety guidelines when handling chemicals, and use protective gear such as gloves and goggles to prevent chemical burns.
• Education: Teach children about the dangers of hot objects and supervise them around potential hazards.
• Smoke Alarms: Install and maintain smoke alarms in the home to provide early warning in case of fire.

When to Refer

Referral to a specialist or hospital may be necessary in the following situations:

• Extensive Burns: If the superficial burn covers a large area of the body or is located on sensitive areas such as the face, hands, feet, joints, or genitals, referral for specialist care may be warranted.
• Infection: If signs of infection develop, such as increased redness, warmth, swelling, or purulent discharge, referral for further treatment may be required.
• Persistent Pain: If the pain from a superficial burn is severe or does not respond to standard treatment, further evaluation may be necessary.
• Delayed Healing: If the burn does not show signs of healing within 7-10 days, or if there are concerns about deeper tissue damage, referral to a specialist is advised.
• Vulnerable Populations: Very young children, elderly patients, or those with comorbid conditions may require specialist assessment.
• Chemical or Electrical Burns: Even if appearing superficial, burns from chemicals or electricity may require specialist evaluation due to potential deeper damage.

References

1. British Burn Association (2024) Guidelines for the Management of Burns. Available at: https://www.britishburnassociation.org (Accessed: 26 August 2024).
2. National Institute for Health and Care Excellence (2024) Burns and Scalds: Diagnosis and Management. Available at: https://www.nice.org.uk/guidance/ng100 (Accessed: 26 August 2024).
3. British National Formulary (2024) Topical Treatments for Burns. Available at: https://bnf.nice.org.uk/ (Accessed: 26 August 2024).