Most burns can be managed on an outpatient basis by primary care physicians

  • 15min
  • May. 2022
  • Supported by
    • La Roche-Posay

Most patients with burn wounds (95%) are treated in the outpatient setting and make primary care physicians the main treatment source for thousands of burn patients each year.
Excellent results can be achieved by primary care physicians with knowledge of basic concepts of burn care.1
Close monitoring and follow-up are important aspects of outpatient management because of the dynamic and fragile progression of burn injuries. Goals of burn management include rapid healing, pain control, return of full function to the injured area, and good aesthetic results.2



How to classify a burn?


Burn depth and size are important factors in determining whether a burn can be classified as minor, and are crucial in dictating the initial steps of burn assessment and management.3

Determination of burn depth can be complicated by the conversion of burns to a higher burn category within the first several days. Conversion occurs when the damaged skin continues to spread and burn depth increases because of thermal injury that did not fully present on initial assessment; therefore, frequent evaluation and reassessment are necessary for all categories of burns.4



What's to be done in practice currently?


Superficial partial-thickness burns often heal in 3 weeks.

  • Silver sulfadiazine is introduced as the gold standard but it has some disadvantages (retardation of wound contracture, delayed and incomplete epithelialization, generation of black scars, limited penetration the depth of the wound, hypersensitivity, neutropenia,...).8
  • Epidermal wounds treated with a water-in-oil-emulsion containing dexpanthenol (a stable alcoholic analog of pantothenic acid) stimulates skin regeneration, reduces erythema and improves elasticity and tissue regeneration in only few days.9

American Burn Association Burn Center Referral Criteria:10

  • Any patient with burns and concomitant trauma (e.g., fractures) in whom the burn injury poses the greatest risk of morbidity or death;
  • Burns in children at hospitals without qualified personnel or equipment for the care of children;
  • Burns in patients who will require special social, emotional, or rehabilitative intervention;
  • Burns in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality;
  • Burns that involve the face, hands, feet, genitalia, perineum, or major joints;
  • Chemical burns;
  • Electrical burns, including lightning injury;
  • Inhalation injury;
  • Partial-thickness burns on more than 10 percent of the total body surface area;
  • Third-degree (full-thickness) burns in any age group.

Bibliography

  1. Gantwerker EA, Hom DB "Skin: histology and physiology of wound healing." Facial Plast Surg Clin North Am. 2011 Aug;19(3):441–53.
  2. Henderson J, Ferguson MW, Terenghi G. "The feeling of healing." Plast Reconstr Surg. 2012 Jan;129(1):223e-224e.
  3. Rougier A, Humbert P. Clinical efficacy on epidermal wound healing of topically applied madecassoside associated with copper/zinc/manganese salts. JAAD, February 2008 Volume 58, Issue 2, Supplement 2, Page AB144.
  4. Crickx b. et al. A French observational study on the management of epidermal wound healing. JAAD, May 2016, Volume 74, Issue 5, Supplement 1, Page AB90
  5. Sun BK, Siprashvili Z, Khavari PA. Advances in skin grafting and treatment of cutaneous wounds. Science. 2014 Nov 21;346(6212):941-5.
  6. Liu M, Dai Y, Li Y. Luo Y. Huang F. Gong Z. Meng, Q. Madecassoside isolated from Centella asiatica herbs facilitates burn wound healing in mice. Planta Med. 2008;74:809–815.
  7. Bylka W, Znajdek-Awiżeń P, Studzińska-Sroka E, Brzezińska M. Centella asiatica in cosmetology. Postepy Dermatol Alergol. 2013 Feb;30(1):46-8.Cao W, Li XQ, Zhang XN, Hou Y, Zeng AG, Xie YH, Wang SW. Madecassoside suppresses LPS-induced TNF-alpha production in cardiomyocytes through inhibition of ERK, p38, and NF-kappaB activity. Int. Immunopharmacol. 2010;10:723–729.
  8. Jung E et al. Madecassoside inhibits melanin synthesis by blocking ultraviolet-induced inflammation. Molecules. 2013 Dec 16;18(12):15724–36.
  9. Proksch E et al. "Topical use of dexpanthenol: a 70th anniversary article." J Dermatolog Treat. May 14, 2017:1–8.