Skin Injuries - Burns and Wounds

Sunburn?

Overexposure to UVA and UVB rays from sunlight or tanning beds/lampss

MAY BE ELIGIBLE FOR SELF CARE → UNDER PROPER CONDITIONS

Thermal Injury?

Flames, scalding liquids, hot objects → cause burn

MAY BE ELIGIBLE FOR SELF CARE → UNDER PROPER CONDITIONS

Electrical burn?

Electricity flows through body, with an entry and exit → and heat causes damage

MUST BE REFERRED

Chemical burn?

Exposure to corrosive or reactive chemicals causing tissue damage

MUST BE REFERRED

How do you assess extent of burns?

Extent → Palmar method → patient’s hand ≈ 1% TBSA

<2 handprints (<2% TBSA) → may be self-treatable

What patient factors increase burn severity/risk?

Elderly patients → thinner/loose skin, decrease in healing → even small burns can be serious

Diabetes mellitus / peripheral vascular disease → increase in risk of complications and poor healing

Superficial thickness / first degree burn?

Painful, does not blister or scar

Redness, no blanching, unbroken surface

Recovery → 3-7 days

Superficial thickness Second Degree burn?

Do not require surgery but → can scar and be more painful

Blisters/weeps

B’n’B → Break and blanching

2 weeks recovery

Which degree burns can be treated with self care?

First degree / superficial thickness

Second degree / superficial partial thickness

Less than 2% of BSA

Unless burn meets exclusion criteria

Deep partial thickness Second degree burn?

Require surgery → form more scars and are less painful

Break in skin, less blanching, blisters are uncommon, altered pain

2-9 weeks recovery

Full thickness / Third degree burn?

Dry, insensitive to light touch/pin prick, small areas will heal with substantial scar

Large areas require skin graft and high risk of infection

White/brown, dry, leathery

Little to no pain

Fourth degree burn?

Involves muscle/bone

Leads to loss of the burned part

Black/charred, no sensation

Which degree burns need hospitalization?

Second degree / intermediate thickness → Notify PCP if 2-10% BSA or hospitalization if over 10% BSA

Third degree → Hospitalization and PT required

Fourth degree → Hospitalization and PT required

Exclusions for burn self treatment?

Sunburn:

• Signs of infection → redness/red streaks spreading or moving away from open blisters

• Open blisters that are draining pus

Minor burns:

• Chemical/electrical/inhalation burns

• Elderly

• Diabetes Mellitus

• Site of injury → hands, face, feet, major joints, genitals/perineum

What are key features of sunburn assessment?

Superficial UV-induced burn

Symptoms peak 12–24 hours after exposure

Most cases have intact skin barrier

When should sunburn be referred for further evaluation?

Blistering

Fever or chills → systemic symptoms

Extensive body surface area involvement

Initial management of sunburns?

Remove further UV exposure immediately

Cool showers/compresses → comfort only, does not limit injury progression

Use of emollients/petrolatum based products

APAP
Avoid topical anesthetics on large areas/broken skin

What are key sun protection counseling points?

Protective clothing + shade

Avoid peak UV hours

Emphasize cumulative skin damage + cancer risk

Use sunscreen regularly

What are the two main types of sunscreen?

Physical/Mineral → zinc oxide, titanium dioxide → reflect UV → good for sensitive skin

Standard chemical → absorbs into the skin and then absorbs UV → needs 15–30 min to activate

How does SPF work?

SPF = time to burn compared to no sunscreen

Ex; 10 min to normally burn → SPF 30 = ~300 min protection

SPF ranges?

Generally SPF is enough unless out for longer than an hour

15 – stops up to 93%

30 – stops up to 97%

50 – stops up to 98%

100 – stops up to 99%

Reapply every 2 hours

Diminishing returns

What are key counseling points for sun protection?

Sun protection needed year-round

“All-day protection” is not reliable → reapply sunscreen regularly

Water/sweat-resistant lasts ~80 min → reapply sooner if rubbed/toweled off

Burned skin is more UV-sensitive → protect carefully

Dark skin still needs sun protection to prevent damage and skin cancer

How should minor burns be cleansed?

Cool → NOT ice-cold water for → 20 min → benefit up to 3 hrs post-burn

Helps reduce pain and limit tissue damage

Mild antiseptic soap to remove debris

Saline not better than clean tap water

Should minor burns be covered?

Sunburn/superficial → no dressing needed, use skin protectant

Partial thickness → non-adherent dressing preferred → gauze or non-stick pads

• Plastic wrap can be used if no dressing available

How should minor burns be managed day-to-day?

Cleanse 3-4 times daily with water or mild antiseptic

Let area air dry

Use non-adherent dressing if needed → partial thickness burns

Do not pop blisters or remove loose skin

What should be done if the burn skin is broken?

Clean with soap and water

Apply moist dressing

Use topical antibiotic → triple antibiotic ointment for prevention

Re-cover after ~30 minutes

Continue protective dressing to prevent infection and promote healing

Scar prevention for minor burns?

Keep wound moist → promotes healing and epithelial migration

Avoid UV exposure, use sunscreen → prevents darkening of scars

Silicone therapy (sheets or gels) → occludes + hydrates tissue to improve/prevent scars (e.g., ScarAway)

What are pharmacologic options for pain management in minor burns?

Acetaminophen → preferred first-line

NSAIDs → caution, stop 48 hrs prior if chance of hospitalization/debridement/skin grafting

What are skin protectants/moisturizers used in minor burn care?

First-line → petrolatum-based products (e.g., Aquaphor®, Vaseline)

Promote moist wound healing

Protect from friction + prevent skin drying

Help reduce scarring

Higher oil content → more moisturizing but greasier/less acceptable to patients

What are topical antibiotics used in minor burn care?

Neosporin → triple antibiotic → bacitracin + neomycin + polymyxin B

Polysporin → bacitracin + polymyxin B

Apply TID with dressing changes

Used for infection prevention → NOT treatment

What are topical anesthetics in minor burn care?

Topical anesthetics → ex; benzocaine, lidocaine

MOA: block sodium channels → stop nerve pain/itch signals

Short acting → 15–45 min relief

Use only on small areas (<2% BSA) and intact skin

What is no longer recommended for minor burn care?

Antiseptics

Acute minor wounds?

Expected to heal normally

Ex; Abrasions, cuts, minor burns

Chronic wounds?

Fail to progress through healing after 4-6 weeks

Are not self care conditions

How do you assess if a minor wound can be treated without referral?

Acute → (<24–48 hrs)

Bleeding controlled with gentle pressure

Superficial → no fat, muscle, or bone exposed

No retained foreign body → no debris left behind

No high-risk factors → ex; diabetes, immunocompromised, advanced age, etc..

If any are NO → refer

Cleaning in managing minor wounds?

Rinse with clean running water to remove debris

Mild soap on surrounding skin only → avoid wound bed scrubbing

Saline not superior to tap water

Avoid routine antiseptics → cytotoxic → delays healing

Controlling bleeding in managing minor wounds?

Apply direct pressure with clean gauze (1–2 min)

Elevate if needed

If uncontrolled → refer

Cover or leave open while managing a minor wound?

Small superficial wounds → may be left open after cleansing + skin protectant

If friction/contamination risk → cover with clean wet dressing

Change daily or if soiled

What is first-line topical therapy for minor wounds?

Petrolatum based products → Vaseline or Aquaphor

Promote moist healing

Decrease scarring and scab formation

What topical antibiotics may be used in minor wounds?

Short-term use for contaminated/high-risk wounds

Prevent infection only → not faster healing

Risk → allergic contact dermatitis → especially neomycin

What is recommended for pain management in minor wounds?

Acetaminophen → preferred first-line

NSAIDs may be used if no contraindications (e.g., bleeding risk/procedures)

What is NOT recommended for routine cleansing of minor wounds?

Routine hydrogen peroxide, chlorohexidine, alcohol, or povidone-iodine

Damages fibroblasts and keratinocytes → delays healing

What is daily antiseptic cleansing NOT recommended for minor wound care?

Not better than water or saline

Can disrupt tissue formation, prolong inflammation, or increase irritation/dermatitis risk

Rapidly neutralized by blood/exudate → very limited antimicrobial benefit

Why are silver containing products not recommended for minor wound care?

No proven benefit in minor wounds

May be cytotoxic to fibroblasts and keratinocytes

Prolonged use may cause antimicrobial resistance

Why should minor wounds NOT be left dry to “air out”?

Oxygen for healing comes from blood → not air

Dry wounds form scabs → which then act as a physical barrier to new skin cell migration → forcing cells to grow under instead of across

Leads to slower healing under scab instead of across surface

Why is moist wound healing preferred?

Faster healing

Less inflammation

Less scarring

What are risk factors for chronic wounds?

Disease state → Diabetes mellitus

Excessive pressure

Immobility

Poor circulation

Immunodeficiency

Infection

Poor nutrition

Advanced age

Obesity

What medications are risk factors for chronic wounds?

Sedative hypnotics

Diuretics

Anticholinergics

Immunosuppressive/anti-neoplastic

coticosteroids

What are venous stasis ulcers?

Irregular, exudative ulcers

Lower extremities → often inner side of ankle

What are arterial ulcers?

Dry, necrotic, painful ulcers

Distal locations → below ankle

What are neuropathic/diabetic ulcers?

Often painless → loss of sensation

Bottom of foot → plantar foot location

Slow to heal

What are pressure injuries / ulcers?

Occur over bony prominences

Most common chronic wound type

Also called bedsores/decubitus ulcers

Staged I–IV based on depth

What are the main goals of chronic wound treatment?

Maintain moist environment to promote healing

Protect from infection → often with occlusive dressings

Protect from trauma → cushioning + non-traumatic dressing removal

Minimize scarring

How are chronic wounds generally treated?

Cleanse with normal saline → best option

Alternatives → commercial cleansers or maggot therapy

Treat infection if present

Debride/remove necrotic tissue as needed

Apply appropriate dressing

Hydrocolloid dressing?

“Melts” into wound environment

Protects skin + reduces pressure

Used for pressure ulcers

Ex; replicare, duoderm

Transparent film dressing?

Adhesive barrier that is gas permeable but blocks fluid

Allows wound visualization

Reduce friction

Used for Stage 1 pressure ulcers or IV sites

Ex; bioclusive, tegaderm

Hydrogel / Amorphous hydrogel dressing sheets?

Moist, cooling dressing

Best for burns, dry/dehydrated, or painful wounds

Helps rehydrate tissue

Ex; Solosite, Intrasite

Regrane?

For diabetic neuropathic foot ulcers

Used after debridement to promote healing

What are pharmacists expected to do?

Perform triage

Provide evidence based self care advice

Identify high risk patients

Refer early and appropriately

What are pharmacists NEVER expected to do?

Stage chronic wounds in detail

Select specialty dressings

Manage debridement plans