Expert: Jim B - 9/27/2006

Question
Hi Jim,
Thanks so much for your super quick reply.
To answer your question- I live in Greece but used to live in the states for a couple of years after high school, so I know US medical practices differ from Eastern European/Balkan ones. In this part of the world, doctors and pharmacists love their iodine, and prescribe it for just about anything, but without being an expert in these issues, it did strike me as a harsh thing for a burn.
Anyway, seeing that the wound is beginning to heal, I am thinking of switching to a Bacitracin based product - there are a couple of brand names available in the market here that have it as a main ingredient.  And then later on, Eucerine cream is also available.
And yes, that "brown skin" is indeed slowly starting to peel off on its own, and what i can see under it is my regular normal-looking skin!!! good to see anything resembling it in that area!!
I wanted to ask something else as well. What's the usual prognosis on scarring in these sorts of burns? ANd is there any particular cream/ointment/anything that is usually used in the US after the wound has healed that reduces scars? Local medicine suggests fish oil based products as well as aloe and vitamin E. What's your view on this?
Thanks again so much! You've been very helpful.
Best,
E.


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Followup To

Question -
Hi there.
I'm 25, female, in good health. I suffered (from what i was told) a 2nd degree burn from boiling water on my thigh a week ago. The area is palm-size. Initially, the whole area was bright red, and then one half of it blistered up (where hot water initially splashed) and the rest was just red. Blisters were popped and cleaned, and that particular area is now just a red/pink color and starting to itch (was told this was a good sign). The rest of the wound (that never blistered and hurt much less than the blistered area) progressively got darker in color. I live out of the US and they use different medicine here but I was told to clean the wound with "Betadine" - povidine iodine 10% and use "Celestoderm V" cream - Betamethasone 17-Valerate & Gentamicin Sulfate. While the blisters were there, they also had me use Fucidine soaked gauzes, but told me to stop a few days ago. The pharmacist has told me I should now start keeping the wound uncovered for it to dry out. What's your opinion on wound care at this stage? THe wound doesn't hurt anymore (it only did the first 3 days) and doesn;t look as wet as it did a few days ago.
Also, the area that never blistered and turned darker in color (it is now the color of tanned skin, and very dry) looks like it will begin to peel off. Is that at all normal?
Thanks much in advance.
Elena

Answer -
Hi Elena,

Wow! That is quite differet than we would do here. The Betasdine (Prov iodine) is a great killer of bacteria but it also kills new skin cells which slows healing. The Combination of betamethasone and Gent is a powerful combination of a very powerful steroid and a heavy-duty antibiotic. The steroid tends to "thin" the skin and also slow healing of wounds, but there are some tests of using it with burns on the theory that it reduces scars.

Anyhow..... Here we are are a stage where with a second degree burn should be re-covering itself with a first thin layer of skin. The Burn protocol here wouldbe to stop the harsher ntibiotics and use the very mild Bacitricin cream to keep the healing wound covered until it stops all oozing of fluids. When the oozing completely stops we would apply a protective cream like Mederma or Eucerine (all over the counter stuff) or even Desitin (diaper rash cream) to protect the very thin skin from drying out as it heals back towards full-thickness.

The "brown" skin will flake off without problems. Let it happen as it does without a lot of interferance on your part.

Hope this helps! Let me know how it goes and where you are located (country-wise).

Jim

Answer
Hi Elena,

My wife and I love Greece, and hope to get back to the islands again in a few years.

Provadine Iodine is not as harsh as is regular old iodine disolved in alcohol, but it is a great killer of a lot of types of nasty bacteria. So, it is not a real shock to see it used in your case. But we would avoid it here.

OK, Second degree burns rarely scar, although sometimes within the second degree areas lurk a few small third degree areas which do scar. The Mederma or Eucerine creams used to protect and cover the burn areas will also reduce the chances for any lasting scars, but expect that the area may heal to a reddish /pinkish color which can persist for several months while the skin heals to its original thickness.

Feel free to ask follow-ups if you have more questions.

Jim