A burn at home: what to do in the first twenty minutes

What is done in the first twenty minutes of a burn largely determines the scar that will be left afterwards. It is the information I would most often have liked a patient to know before reaching my consulting room.

What to do

1. Running cold water for twenty minutes. From the tap, cool rather than freezing. Not iced. No ice. Twenty real minutes, watching the clock: it is how long it takes for the heat held in the skin to disperse, and almost everybody stops at two.
2. Remove clothing that is not stuck, and rings, bracelets and watches before the area swells. Anything adhering to the skin stays where it is.
3. Cover with a clean cloth, dry and lint-free. Nothing else on top.
4. Go to an emergency department. Always if it is a child, if it affects the face, hands, feet, genitals or joints, if it is extensive, if it goes all the way round a limb, if it was electrical or chemical, or if the skin looks white, leathery or does not hurt.

A burn that does not hurt is a bad sign, not a good one: it means it destroyed the nerve endings.

What must never be done

Spelling this out because it is still done every day in Peru, and it makes the injury worse:

• Toothpaste.
• Oil, cooking or any other kind.
• Egg white.
• Potato, lard, butter, coffee, herbs, mud.
• Ice directly.
• Bursting the blisters.

Everything in the first list does the same thing: it traps the heat inside the skin instead of drawing it out, contaminates the wound and prevents the real depth being assessed when you finally reach the emergency department. Ice adds its own damage, because the vasoconstriction worsens an area already compromised. And a blister is a sterile cover: while it holds, it protects.

There is no home remedy that improves a burn. All the ones in use make it worse, and some decide the difference between a scar and no scar.

Why it is reassessed at 48 hours

Burns have a particularity that surprises families: they deepen over the first forty-eight hours. What looks superficial on the first day can turn out deeper on the third, which is why the assessment is repeated.

Everything else depends on the real depth. A superficial burn heals by itself in one or two weeks and leaves no mark. A deep one will never close on its own and needs debridement and grafting. Grafting in good time what is not going to close by itself is the decision that most reduces the final scar.

Hence why waiting weeks "to see if it closes on its own" is the expensive mistake: the longer a wound takes to close, the worse the scar it leaves.

Afterwards, for months

Once the wound has closed the other half of the work begins, and it lasts between six months and two years: compression with made-to-measure garments, moisturising, silicone sheets, massage and strict sun protection. It is tedious and it is what separates a flat scar from a contracted one.

A deep burn is not promised to leave no scar: it always does. What does change the outcome a great deal is the time to closure and the care over the following months.

Keep this before you need it

Household burns happen in the kitchen, with boiling water and with oil, and most of the serious ones in Peru are in small children. When it happens, nobody looks up information: people do whatever somebody remembers. Let what you remember be twenty minutes of water.