Expert: Jim B - 5/30/2007

Question
My son was accidently tipped into a bonfire and has 2nd degree burns on his arm from just above the elbow to the wrist (the worst is at the elbow).  He did go to the emergency room and get treatment.  Each day, we have been rinsing it under a light spray of water and applying silvadene (sp) ointment, covering the burns with gauze pads and gauze wrap.  But, it seems that some of the silvadene forms a bit of a white pasty coating (kind of like Desenex does on a babie's bottom) and is difficult to rinse off.  I'm not sure about actually wiping this off, as it seems it would do damage to the burned skin underneath.  I see that you have told others to open blisters and get rid of dead skin...but how is this accomplished?  Do we use a tongue depressor?  I am concerned about doing more harm than good.  Any helpful hints you can give us will be greatly appreciated.  Thanks so much!

Answer
Hi Deb,

Anything you use to work on an open burn should be more than clean. Tongue depressors that come in a sealed little envelope are fine. As to the old silvadene, it should really come off. For a burn this size I would recommend surgical soap or Betadine cleanser using regular tap water. It should be lukewarm for comfort. If he was given an oral pain medication have him take it 20 to 30 minutes before changing the dressing for best effect at the worst time. If the blisters are broken they can usually be gently lifted with you sterile tone depressor and then pulled free with your fingers. The trick here is touch only what will come off so that what you have touched does not go back onto the open burn. Blisters usually will simply and painlessly tear off around the edges when pulled slightly at an angle to the edge. Not everything has to be done at once. If you are having problems with a lot of pain in the morning do some of the burn and do some more that evening. When you have to get down to touch the surface of the burn use fresh 4" X 4" gauze pads Keep your fingers on one side of the gauze and save the other side for the burn. Wash the burn after removing any dead blister (you can use gauze to wash with too) and apply a thin coat of Silvadene. Cover with gauze and wrap. When the blisters are off there will be seepage of fluids. Expect this and be sure to re-wash and dress the burn if the dressing becomes wet through. This should be pretty much a week to ten days chore. You will (or should) note that some very thin skin and some scabs will form after about 7 days and the wound will begin to stop seeping. After ten days you should stop using the Silvadene and use the very mild Bacitracin, as this is less likely to slow healing as Silvadene does. Watch carefully for any sign of infection especially small black pits in the burn surface or bright green streaks in the Silvadene. Watch for strange or new odors as well. If any of these show up have the doctor take a look quickly as there are some nasty bugs out there that seem to love burns, esp one called pseudomonas. Apart from this remember that these should all heal without a lasting scar although redness may be around for up to a year. Remember my other standard advice as well about sunblock after the burn has skinned over and a dressing is no longer needed.

Feel free to follow up. I know this has been no fun for anyone.

Jim