The Right Way to Treat Burns, According to Dermatologists

Marci Robin

Like so many afflictions and incidents that affect our skin, burns can have both a cosmetic and injurious impact. Beyond the pain of getting a burn, you could be at risk of infection, nerve damage, and mobility limitation, depending on the degree and type of burn; and once the initial health concerns have passed, you're faced with the possibility of discoloration and scarring.

While we can make choices to avoid risky behavior — if you've never handled fireworks before, why start now? — some accidents are unavoidable, whether it's losing your grip on a curling wand, being splashed as you move a pot of boiling water, or having a bad experience with a chemical relaxer. Thankfully, there are wise ways to handle a burn in the moment, while it's healing, and if a scar arises.

"In my practice, I help rehabilitate old scars regardless of cause and treat patients with new burns to minimize the impact of scarring as well as skin discoloration," explains Thomas Beachkofsky, who says a board-certified dermatologist like himself can help you evaluate if treatments like lasers, microneedling, topical creams, or injectable medications are options when you've developed a burn scar.

But before you look into cosmetic treatments after a burn, you can prepare yourself with the knowledge you need to handle every phase of a burn should you experience one. We spoke to experts on how to identify different types of burns, support the healing process, treat the aftermath, and more.

What do different burn degrees indicate?

When people refer to the degree of a burn, it's an indication of the depth of damage. First-degree burns damage the epidermis (top layer) only. "First-degree burns usually result in pink to red skin discoloration with minimal swelling and minimal to moderate discomfort and can often be cared for at home," Beachkofsky explains. A second-degree burn goes a bit deeper, affecting both the epidermis and dermis (skin's bottom layer) and typically causes blisters.

"When the extent of blistering is smaller than the size of your hand, many second-degree burns can also be cared for at home," says Beachkofsky, who urges not to pop the the blisters — just place a clean bandage on them. "Second-degree burns that are larger than the palm of your hand require emergency attention." The same goes for second-degree burns crossing a joint or involving the face, fingers, toes, or genitals because there's a higher risk for disfigurement and scarring that may limit mobility.

Third-degree burns are called "full thickness burns" because they damage the entire epidermis and dermis, Beachkofsky explains, while fourth-degree burns cause the deepest damage, reaching the muscle, tendons, and bones. "When a person gets a third- or fourth-degree burn, the skin will appear charred and can appear white, brown, or black. In these situations, the risk of scarring, infection, and pain is high, and emergency attention is recommended."

What's the difference between a thermal burn and a chemical burn?

In addition to degrees, there are several types of burns in terms of their cause. Electromagnetic radiation and electricity can cause burns, but the two most common types are thermal and chemical burns.

"Thermal burns are what occur when your skin comes in contact with something so hot that the proteins that the skin cells are made up of start to denature and break down," Beachkofsky says. "This can occur with lower temperature exposures over a longer period of time such as the extended use of heating pads placed directly on the skin or with higher temperatures exposures over shorter periods such as a curling-iron burn on your forehead or spilling a hot drink on your skin."  

Chemical burns, on the other hand, can be the result of exposure to acidic cleaning products like bleach, basic products like vinegar, and even hair relaxers and straightening formulas. "Many of these hair-treatment products contain sodium hydroxide — which is better known as lye — and prolonged scalp exposure during hair treatments may result in a burn," Beachkofsky says. 

Annie Gonzalez, a board-certified dermatologist based in Miami, adds that their severity depends on the length of contact, the chemical's corrosiveness, and the temperature. Regardless of whether the burn is thermal or chemical in nature, however, the outcomes are very similar. "Both destroy tissue and cause nerve damage," Gonzalez says.

What should you do immediately after you've suffered a burn?

If you have just experienced a burn, Beachkofsky says it may be difficult to know right away how much damage has occurred. "Your heart is likely to be racing, you are likely in pain, and you may not be thinking clearly. Take a deep breath, try to calm yourself down, and assess the situation," he says, recommending that you move to a safe environment and ask those around you to help evaluate your injuries and administer first aid.  

"Take off any clothing or jewelry near the burnt skin, but do not remove anything that is stuck to it," Gonzalez advises.

For less serious burns that don't require emergent attention, Beachkofsky says to flush them with lukewarm water for 10 to 20 minutes; this will slow the initial injury and reduce pain. "While cold water and ice may sound like a good idea and help decrease discomfort, they can have detrimental effects on blood flow and can lead to a more significant injury," he says. 

The same goes for chemical burns — but not all chemical burns. "You do not want to flush chemical burns with water if the chemical is known to react with water," Beachkofsky says. If you're unsure, he advises calling the Poison Help Line at 1-800-222-1222 for guidance.

Regardless of the apparent severity of a chemical burn, however, you should seek medical attention, especially if the chemical has come in contact with your face, is causing breathing difficulties, or is covering a larger area of your body.

What should you do if you're burnt by fireworks?

Burns from fireworks generally fall under the category of thermal burns and should be treated as such. However, because they often occur on the hands and can be quite injurious, they require an especially diligent approach.

"Any substantial or serious burn in the hand area should be looked at by a professional," says Gonzalez. "Your hands have one of the highest concentrations of nerve endings in the body and are susceptible to damage." That said, a first-degree burn from a firework can be treated with lukewarm water and aloe vera.

If you manage to singe your eyebrows with fireworks or sparklers, it may look worse that it actually is. "If only the hair was singed and not the hair follicle, then the hair will certainly grow back," Gonzalez says, noting that it can take between four and six months for your eyebrows to completely grow back. "Severe damage to the hair follicle may require surgery to replace the hair," adds Gonzalez.

What's the healing process of a burn?

As icky as blisters may look, they're an important first step in the healing process of a burn. "You don't want to pop or irritate these blisters as they are helping your skin heal," Gonzalez says, echoing Beachkofsky's earlier advice. "Under those blisters, white blood cells are helping to ward off bacteria to prevent an infection."

As for things you can do to encourage healthy healing, Beachkofsky recommends keeping the skin clean and covered with an ointment or bandage until it's no longer open or oozing. "This helps to reduce the chances of a secondary infection and provides a moist environment in which the skin is protected and can more easily heal than if the skin is allowed to dry out and scab," he says. 

Even once the need for a bandage or ointment has passed, skin may still be pink, red, tight, itchy, painful, hyperpigmented (dark brown), or depigmented (white). “At this point in wound healing,” Beachkofsky says, "we have new treatments that can further rehabilitate the healing skin and reduce or remove the unwanted skin discoloration." Which brings us to… 

What can you do if you end up with scarring?

Scarring from burns can range from significant changes in skin texture to a darkening or lightening of the skin. "Skin pigment normally resides in the epidermis and is evenly distributed between the skin cells providing an even skin tone," says Beachkofsky, who explains that, following a burn, this pigment can become trapped in the dermis like tattoo ink. "It is difficult for the body to remove the skin pigment from this location, and this process can take months to years to see improvement from mild to moderate burns while severe burns often result in permanent discoloration." That's where lasers come in.

"It may sound crazy that we would injure the skin with a laser to make it heal better, but that is exactly what we do," says Beachkofsky of in-office treatments. "Nanosecond and picosecond lasers such as a PiQo4 can be utilized to help stimulate the removal of hyperpigmented skin discoloration associated with burn injuries, similar to the process of laser tattoo removal."  (Beachkofsky is a spokesperson for Lumenis Aesthetic, the company behind PiQo4)

Beachkofsky says that depigmented scars are more difficult to treat; however, newer technologies allow for autologous melanocyte transfer in which you can transplant your own melanocytes (skin's pigment-producing cells) into areas where they can grow and normalize skin tone.

"[Picosecond lasers] are probably not one of my top choices for burn scars," says board-certified dermatologist Heidi Prather when asked about PiQo4, noting that another type of laser — pulsed dye lasers or PDL, such as Vbeam — may be especially effective on reddened burn scars. 

If the scar is more complicated than discoloration, there are lasers to address those concerns, too. Prather says CO2 ablative fractional lasers are the gold standard for scars with contracture and scars that are hypertrophic (raised). Beachkofsky agrees, telling Allure, "Medical laser therapies with low-density, fractionated, micro-ablative carbon dioxide lasers such as the [Lumenis] UltraPulse and AcuPulse have been shown to rehabilitate scars and guide the wound-healing process in an organized fashion that improves aesthetic outcomes, reduces symptoms of itching and burning, and further restores skin flexibility."

Ultimately, Prather says, "All laser treatments require multiple treatments for optimal results and should be handled by an expert in skin and lasers," which means a board-certified dermatologist plastic surgeon who has specialized in laser treatment of scars.

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Originally Appeared on Allure

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