Burns can occur any time the skin comes in contact with something hot. There are many factors that will contribute to the severity of the burn including what the skin was burned with and how long it took to remove the skin from the heat source. Most people will experience some minor burns on their hands several times throughout their lifetime. However, burns to the hand are not something that should be taken too lightly as they can result in serious short or long term disability. When the skin gets burned it loses a lot of its mobility and its defenses against infection are weakened. Untreated hand burns can result in serious infections, impaired function, and long term scarring. Proper treatment of a burn can help mitigate some of those risks and prevent long term damage.
Remove contact with the heat source
For any burn, the skin should be immediately removed from contact with the heat source. Removing the heat source prevents the burn from continuing to get worse.
For an induction burn, where the person has simply touched a hot surface, it can be easy to move away from the heat. However, burns involving spills of hot liquid, fire, or chemicals can be more difficult.
Remove any clothing or jewelry covering the burn area
Fabrics and jewelry can hold onto chemicals and hot liquids. It is important to remove any contacted clothing quickly so that it does not continue to burn the skin.
Do not remove anything that is stuck to the skin. If fabric or jewelry has fused to the skin it will need to be removed by a medical professional in order to not cause further harm.
Even if there is nothing on the clothing or jewelry itself that is causing the burn, it may still be best to remove anything near the burn area. Burns can swell quickly, items that fit comfortably can quickly become too small and may cut off circulation and cause more damage if they are not removed immediately.
Do not put ice on it
Many people’s first reaction to a burn is to put ice or cold water on it. However, the drastic temperature change from very hot to very cold can cause a lot of damage.
The best thing to do with a burn is to run it under slightly cool water for several minutes or until the skin has stopped retaining heat.
Stay away from any oil based treatments
Oil based treatments including butter and most lotions trap heat in causing the burn to feel more painful and slowing down the healing process.
It is best to use products specifically designed for burn treatment and wrap a protective layer of gauze over the burn to help prevent infection.
Keep it elevated
Keeping the burned hand or wrist elevated above the heart can help limit the amount of swelling that occurs at the burn site. By reducing the swelling, the hand is less likely to lose the ability to move and function properly as the burn heals.
Severe burns to the hand and wrist are at risk for developing Contractures, a condition where normally elastic tissue like muscles or tendons become inelastic, which can cause loss of movement and joint deformities. This condition is linked to increased swelling, so keeping the hand elevated can help reduce the risk while determining the extent to which medical treatment is necessary.
Types of Burns
Burns are classified based on their severity.
First Degree burns, also called superficial epidermis burns, are the least serious. They occur when the burn only reaches the outermost layer of skin, called the epidermis. Typically they will appear red and slightly swollen. Most First degree burns will go away on their own within about a week. Over the counter pain medication can help with the discomfort and swelling of the burn while drinking plenty of water and keeping the skin hydrated will help it heal faster. A mild sunburn is an example of a First Degree burn.
Second Degree burns occur when both the first and second layers of skin have become burnt, they are also called Superficial Dermal Burns. In a second Degree burn, the epidermis and part of the dermis are damaged. The skin will be red and painful and will start to blister. A doctor may recommend a gauze wrap or splint to help treat a Second Degree burn and prevent too much stretching of the burned skin while it heals. Any open sores caused by the blistering will require frequent cleaning with antibiotics and will need the gauze changed regularly to keep them from becoming infected.
Third Degree burns happen when the dermal layer of the skin is fully damaged by the burn. They are also called Deep Dermal or Partial Thickness Burns. These burns can have large blisters, or the skin may become white or leathery. Third Degree burns can either be very painful or entirely painless at the burn location. With a Third Degree burn, the dead skin will need to be removed and new skin will need to be grafted onto the area. The hand and wrist will most likely need to be splinted for at least a few weeks so that the fresh skin has time to heal without being moved or stretched.
Fourth Degree burn is when the burn damage goes entirely through the skin and begins to damage the underlying layers of fat, tissue, and muscle. Underneath the Dermis layer of skin is a layer of Subcutaneous Fat and tissue that protects the bones and muscles below the skin. In these types of burns the skin may appear black, brown, or white and will be dry with no blisters, it may also have a leathery or waxy texture. In some cases the skin may be burned away entirely exposing the tissue underneath. This type of burn will always need a skin graft to replace the missing or dead skin and will often need treatment to any other damaged areas.
Therapy and Rehabilitation
The severity of the burn will play a big factor in the type of treatment needed. Any burn can leave the damaged skin very stiff. Superficial burns like First and Second Degree burns will typically not need specialized rehabilitation after the skin heals. However, more severe burns may require formal rehabilitation training to overcome the effects of Contractures and allow the hand and wrist to move normally.
Seek medical attention
For any burn Second Degree or worse it is always best to seek medical attention. It is also best to seek attention for any burn that covers the majority of the hand or wrist since the extent of damage may not always be easily known.
Burns should always be treated as quickly as possible. Waiting to treat a burn can result in far more damage than would have otherwise occurred.
When in doubt, it is always best to seek medical attention about a burn.
* This article was originally published by The Hand and Wrist Institute*
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