Burns

Also indexed as: Sunburn

Burns are damage to tissue that can result from exposure to extreme heat, chemicals, electricity, or radioactive material.

For minor burns, natural medicine may be helpful after the burn is cleaned with soap and cold water and gently dried. Because of the risk of infection, topical applications should not be made to blistered or open burn wounds, unless under medical supervision. Extensive burns or burns causing more than minor discomfort should be treated by a healthcare professional.

Checklist for Minor Burns

Rating Nutritional Supplements Herbs
3Stars

Vitamin C, in combination with Vitamin E (for prevention of sunburn only)

  
2Stars

Vitamin D (for extensive burns)

Aloe
1Star

Colloidal silver

Vitamin E (topical, for minor burns)

Calendula

Gotu kola

Plantain (topical)
See also:  Homoeopathic Remedies for Minor Burns
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms of burns?

Symptoms depend on the severity and cause of the burn but usually include pain and sensitivity to touch. The skin may appear swollen, blistered, dried, charred, weeping, or red, grey, or black-colored.

Medical treatments

Over the counter lotions, creams, and sprays are used to provide temporary relief of pain due to minor burns. Some products contain a local anaesthetic, such as lidocaine (Solarcaine Aloe Extra Burn Relief®) and benzocaine (Solarcaine®, Americaine Anaesthetic®, Lanacane®, Dermoplast®). Other products contain vitamins A, D, and E (A and D Ointment®, Coppertone Cool Beads®), as well as aloe vera (Pacquin Plus with Aloe®, Coppertone Cool Beads®).

The prescription medications silver sulfadiazine (Silvadene®) and mafenide (Sulfamylon®) are used topically to prevent and treat uncomplicated bacterial infection in second and third degree burns, as are oral antibiotics such as levofloxacin (Levaquin®) and cephalexin (Keflex®).

Severe burns require hospitalisation. They are typically treated by surgical removal of burned tissue followed by grafting of skin or synthetic substitutes.

Dietary changes that may be helpful

The body repairs and builds new tissues in a process called anabolism. Adequate amounts of calories and protein are required for anabolism, as the skin and underlying tissues are comprised of protein and energy is needed to fuel repair mechanisms. While major injuries requiring hospitalisation raise protein and calorie requirements significantly, injuries such as minor burns should not require changes from a typical, healthful diet.1

Nutritional supplements that may be helpful

Antioxidants may protect the skin from sunburn due to free radical-producing ultraviolet rays.2 Combinations of 1,000 to 2,000 IU per day of vitamin E and 2,000 to 3,000 mg per day of vitamin C, but neither given alone, have a significant protective effect against ultraviolet rays, according to double-blind studies.3 4 5 Oral synthetic beta-carotene alone was not found to provide effective protection in a recent double-blind study,6 it may be effective in combination with topical sunscreen.7 However, other carotenoids such as lycopene may be more important for ultraviolet protection. One recent uncontrolled trial found 40 grams per day of tomato paste providing 16 mg per day lycopene for 10 weeks protected against burning by ultraviolet rays.8 Another uncontrolled trial found 25 mg/day of natural mixed carotenoids also protected against ultraviolet radiation, especially when combined with 500 IU per day of vitamin E.9

Double-blind research has also shown that topical application of antioxidants protects against sunburn if used before,10 but not after, exposure.11 12

Despite a lack of research on the subject, using vitamin E topically on minor burns is a popular remedy. This makes sense, because some of the damage done to the skin is oxidative, and vitamin E is an antioxidant. Some doctors suggest simply breaking open a capsule of vitamin E and applying it to the affected area two or three times per day. Vitamin E forms are listed as either “tocopherol” or “tocopheryl” followed by the name of what is attached to it, as in “tocopheryl acetate.” While both forms are active when taken by mouth, the skin utilizes the tocopheryl forms very slowly.13 14 Therefore, those planning to apply vitamin E to the skin should buy the tocopherol form.

Burns affecting a large proportion of the body may result in vitamin D deficiency15 , potentially increasing the risk of osteoporosis, which is a frequent long-term consequence of severe burns.16

Colloidal silver has been used as a topical antiseptic for minor burns for over a century. Internal use of colloidal silver is not recommended for this condition.

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Aloe is another popular remedy for minor burns and a small preliminary study found it more effective than Vaseline in treating burns.17 The stabilized aloe gel is typically applied to the affected area of skin three to five times per day. Older case studies reported that aloe gel applied topically could help heal radiation burns,18 but a large, double-blind trial did not find aloe effective in this regard.19

Calendula cream may be applied to minor burns to soothe pain and help promote tissue repair. It has been shown in animal studies to be anti-inflammatory20 and to aid repair of damaged tissues.21 The cream is applied three times per day. Plantain is regarded as similar to calendula in traditional medicine, though usually the whole leaf is applied directly to the burn as a poultice.

Gotu kola has been used in the medicinal systems of central Asia for centuries to treat numerous skin diseases. Saponins in gotu kola beneficially affect collagen (the material that makes up connective tissue) to inhibit its production in hyperactive scar tissue following burns or wounds.22

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

Integrated approaches that may be helpful

Acupuncture may be useful in the treatment of serious burns. A report of patients suffering from extensive second-degree burns suggests acupuncture can reduce shock and pain following the acute injury and may reduce infection and pain when used as a part of post-injury wound care.23 A preliminary report described ten patients with second-degree burns that did not respond to conventional medical treatment. A majority of these patients achieved greater than 90% recovery following electrical stimulation to the wound (similar to electroacupuncture).24 Ear (auricular) acupuncture with electrical stimulation was studied in a small controlled trial, in which a significantly greater reduction in pain from burns was achieved with acupuncture. The relief lasted at least 60 minutes following acupuncture treatment.25

References

1. Souba WW, Wilmore D. Diet and nutrition in the care of the patient with surgery, trauma, and sepsis. In Shils ME, Olson JA, Shike M, et al. Modern Nutrition in Health and Disease, 9th ed. Baltimore: Williams & Wilkins, 1999, 1589–618.

2. Fuchs J. Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in . Free Radic Biol Med 1998;25:848–7.

3. Fuchs J, Kern H. Modulation of UV-light-induced skin inflammation by D-alpha-tocopherol and L-ascorbic acid: a clinical study using solar simulated radiation. Free Radic Biol Med 1998;25:1006–12.

4. Eberlein-Konig B, Placzek M, Przybilla B. Protective effect against sunburn of combined systemic ascorbic acid (vitamin C) and d-alpha-tocopherol (vitamin E). J Am Acad Dermatol 1998;38:45–8.

5. Werninghaus K, Meydani M, Bhawan J, et al. Evaluation of the photoprotective effect of oral vitamin E supplementation. Arch Dermatol 1994;130:1257–61.

6. Garmyn M, Ribaya-Mercado JD, Russel RM, et al. Effect of beta-carotene supplementation on the human sunburn reaction. Exp Dermatol 1995;4:104–11.

7. Gollnick PM, Hopfenmuller, W, et al. Systemic B-carotene plus topical sunscreen are an optimal protection against harmful effects of natural UV-sunlight. Eur J Dermatol 1996;6:200–5.

8. Stahl W, Heinrich U, Wiseman S, et al. Dietary tomato paste protects against ultraviolet light-induced erythema in humans. J Nutr 2001;131:1449–51.

9. Stahl W, Heinrich U, Jungmann H, et al. Carotenoids and carotenoids plus vitamin E protect against ultraviolet light-induced erythema in humans. Am J Clin Nutr 2000;71:795–8.

10. Dreher F, Gabard B, Schwindt DA, et al. Topical melatonin in combination with vitamins E and C protects skin from ultraviolet-induced erythema: a human study in vivo. Br J Dermatol 1998;139:332–9.

11. Dreher F, Denig N, Gabard B, et al. Effect of topical antioxidants on UV-induced erythema formation when administered after exposure. Dermatology 1999;198:52–5.

12. Fuchs J. Potentials and limitations of the natural antioxidants RRR-alpha-tocopherol, L-ascorbic acid and beta-carotene in cutaneous photoprotection. Free Radic Biol Med 1998;25:848–73 [review].

13. Beijersbergen van Henegouwen GM, Junginger HE, de Vries H. Hydrolysis of RRR-alpha-tocopheryl acetate (vitamin E acetate) in the skin and its UV protecting activity (an in vivo study with the rat). J Photochem Photobiol B 1995;29:45–51.

14. Norkus EP, Bryce GF, Bhagavan HN. Uptake and bioconversion of alpha-tocopheryl acetate to alpha-tocopherol in skin of hairless mice. Photochem Photobiol 1993;57:613–5.

15. Klein GL, Chen TC, Holick MF, et al. Synthesis of vitamin D in skin after burns. Lancet 2004;363:291–2.

16. Garrel D. Burn scars: a new cause of vitamin D deficiency? Lancet 2004;363:259–60.)) Vitamin D deficiency may result from the inability of previously burned skin to manufacture vitamin D after exposure to sunlight. People with a history of an extensive burn might benefit from vitamin D supplementation.

17. Visuthikosol V, Chowchuen B, Sukwanarat Y, et al. Effect of aloe vera gel to healing of burn wound: A clinical and histologic study. J Med Assoc Thai 1995;78:403–9.

18. Loveman AB. Leaf of Aloe vera in treatment of Roentgen ray ulcers. Arch Derm Syph 1937;36:838–43.

19. Williams MS, Burk M, Loprinzi CL, et al. Phase III double-blind evaluation of an Aloe vera gel as a prophylactic agent for radiation-induced skin toxicity. Int J Rad Oncol Biol Phys 1996;36:345–9.

20. Della Loggia R, Tubaro A, Sosa S, et al. The role of triterpenoids in the topical anti-inflammatory activity of Calendula officinalis flowers. Planta Medica 1994;60:516–20.

21. Patrick KFM, Kumar S, Edwardson PAD, Hutchinson JJ. Induction of vascularisation by an aqueous extract of the flowers of Calendula officinalis L the European marigold. Phytomedicine 1996;3:11–8.

22. Werbach MR, Murray MT. Botancial Influences on Illness. Tarzana, CA: Third Line Press, 2000, 143–7.

23. Jichova E, Konigova R, Prusik K. Acupuncture in patients with thermal injuries. Acta Chir Plast 1983;25:102–8.

24. Sumano H, Mateos G. The use of acupuncture-like electrical stimulation for wound healing of lesions unresponsive to conventional treatment. Am J Acupunct 1999;27:5–14.

25. Lewis SM, Clelland JA, Knowles CJ, et al. Effects of auricular acupuncture-like transcutaneous electric nerve stimulation on pain levels following wound care in patients with burns: a pilot study. J Burn Care Rehabil 1990;11:3229.