Burns are skin injuries caused by either ultraviolet light radiation (sunlight, other sources of ultraviolet light), thermal agents (flames, hot liquids, hot objects, hot gasses), electricity (voltage exposure), and chemicals (acids and alkalis). A burn injury of the skin causes protein denaturation, wound edema, and loss of tissue fluids due to increased vascular permeability. Depending on the severity of the burn, complications can include skin infection, systemic infection, fluid and electrolyte loss, and shock. All are complications that pose a legitimate threat to one’s life.
Most minor burns, such as contact burns and scalds, occur in the home and are often caused by household accidents, like a sudden a exposure to a hot liquid (i.e. boiling water) or hot stove. Outside of the home, sunburn is the most common minor burn. Sunburn occurs from prolonged exposure to sunlight and can be easily prevented by the topical application of sunscreens.
Burn classifications are dependant upon the severity of damage to skin. The three categories of burns are:
- First-degree or superficial burns (affects only the outermost layer of the skin)
- Second-degree or partial thickness burns (affects the underlying skin layers, dermis, sweat glands, and hair follicles)
- Third-degree or full-thickness burns (affects all layers of skin and possibly underlying tissues such as nerves, fat tissue, and muscle).
According to the National Institute of General Medical Sciences (NIGMS), a department of the National Institutes of Health; (1)
- An estimated 1.1 million burn injuries require medical attention each year in the United States
- Approximately 10,000 people in the United States die every year due to burn-related infections
- Twenty years ago, burns covering 50 percent of the body were routinely fatal; today, patients with burns covering 90 percent of the body can survive (but often with permanent impairments).
Each category of burn exhibits its own unique symptoms and serves as a guide for assessment and treatment. Symptoms vary by individual and may include the following:
First degree burns
- Affects the outermost layer of the skin
- Sensitive to the touch
- Surface blanches to light pressure
- Medical assistance is usually not required, unless the burn covers more than 5 percent of the body surface.
Second degree burns
- Affects the underlying skin layers (dermis, sweat glands, and hair follicles)
- Surface blanches to light pressure
- Medical assistance may be required.
Third degree burns
- Affects all layers of skin and possibly underlying tissues (nerves, fat tissue, and muscle)
- Skin may look red, white or yellowish, or leathery and black
- Little or no pain (nerve endings have been damaged)
- May take months to heal
- Causes Scarring
- Greater possibility of complications including skin infection, systemic infection, fluid and electrolyte loss, and shock, which can pose a threat to life.
- Skin grafts may be necessary
- Urgent medical assistance is required.
Treatment options are directly dependant upon the severity of a burn. First-degree burns and small second-degree burns may be self-treated with applications of cold water for a minimum duration of 10 minutes. Afflicted areas of skin, in the severest of minor burns, are usually covered with both a sterile dressing and various topical corticosteroids or anti-infective ointments. Medical attention is required when there is an accompanied blistering. However, with attentive treatment and routine wound care, minor burns usually heal on their own within 2 weeks.
Conversely, severe burns, including chemical and electrical burns, require immediate medical attention. A third-degree burn that affects all layers of the skin may require surgical intervention. Skin grafts and vascular or reconstructive surgery is probable. Severe burns are also treated with antimicrobial drugs, such as silver sulfadiazine and hydrolyzed collagen, to prevent skin and systemic infections.
Vitamin C supplementation enhances immune function and promotes wound healing (2). In a clinical study, 37 burn patients were randomly divided into ascorbic acid and control groups. The patients who were treated with high-dose ascorbic acid experienced significantly reduced resuscitation fluid volume requirements, severity of respiratory dysfunction, and wound edema (3).
Supplementation with the amino acid arginine has been shown to increase the amount of reparative collagen during the wound healing process (4). One study has even demonstrated a successful recovery of burn patients with arginine treatment (5).
Glutamine amino acid levels are often low in burn patients (6). Supplementation with glutamine can produce clinical improvement in burn patients (7).
Zinc is an important component of our immune and enzyme systems, and also aids in wound healing and tissue growth (8). Zinc serum levels are often low in burn patients. Topical application of zinc has been found to enhance wound healing (9). However, supplementation with excess zinc can inhibit wound healing.
Aloe vera is a succulent plant, which yields potent healing properties. Studies show that aloe vera leaf gel is an effective burn and wound healing agent (10-12). Aloe can be applied directly on the wound in topical treatments, or be administered via ingestion for not only wounds, but also gastrointestinal ulcers (13).
Bromelain, a protein-digesting enzyme complex derived from pineapple, can be helpful in healing burns and chronic wounds. It may also assist in the degradation of scar tissue in certain wounds (14).
1. The National Institute of General Medical Sciences (NIGMS): http://www.nigms.nih.gov/news/facts/traumaburnfactsfigures.html
2. Head, K.A. Ascorbic acid in the prevention and treatment of cancer. Altern. Med. Rev. 1998 Jun; 3(3): 174-86.
3. Tanaka H, et al. Reduction of resuscitation fluid volumes in severely burned patients using ascorbic acid administration: a randomized, prospective study. Arch Surg. Mar2000;135(3):326-31.
4. Kirk, S.J., Hurson, M., Regan, M.C. et al. Arginine stimulates wound healing and immune function in elderly human beings. Surgery 1993 Aug; 114(2):155-9; discussion, 160.
5. Lu SL. Effect of arginine supplementation on T-lymphocyte function in burn patients. Chung Hua Cheng Hsing Shao Shang Wai Ko Tsa Chih. Sep1993;9(5):368-71, 398.
6. Parry-Billings M, et al. Does glutamine contribute to immunosuppression after major burns? Lancet. Sep1990;336(8714):523-5.
7. De-Souza, D.A., Greene, L.J. Pharmacological nutrition after burn injury. J. Nutr. 1998 May; 128(5): 797-803.
8. Okada A, et al. Zinc in clinical surgery: a research review. Jpn J Surg. 1990;20:635.
9. Prasad AS. Zinc and growth in development and the spectrum of human zinc deficiency. J Am Coll Nutr. 1988;7:377.
10. Visuthikosol V, et al. Effect of aloe vera gel to healing of burn wound a clinical and histologic study. J Med Assoc Thai. Aug1995;78(8):403-9.
11. Rodriquez-Bigas M, et al. Comparative evaluation of aloe vera in the management of burn wounds in guinea pigs. Plast Reconstr Surg. Mar1988;81(3):386-9.
12. Somboonwong J, et al. Therapeutic effects of Aloe vera on cutaneous microcirculation and wound healing in second degree burn model in rats. J Med Assoc Thai. Apr2000;83(4):417-25.
13. Chithra, P., Sajithlal, G.B., Chandrakasan, G. Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats. Mol. Cell. Biochem. 1998 Apr; 181(1-2): 71-6.
14. Maurer HR. Bromelain: biochemistry, pharmacology and medical use. Cell Mol Life Sci. 2001 Aug;58(9):1234-45.
15. Miriam Stoppard, MD., Family Health Guide, (New York, NY: DK Publishing, 2002).
16. James F. Balch and Phyllis A. Balch, Prescription for Nutritional Healing, 3rd ed. (New York, NY: Penguin Putnam Avery, 2000).
17. Merck Manual eds, The Merck Manual of Diagnosis and Therapy, (Rahway,NJ: Merck & Co., Inc, 1997).