When to seek treatment at a burn center

“Why do I have to drive into the middle of D.C. to a burn center? There’s a hospital right by me.”

We hear this question all the time. I answer that burns are wounds, but wounds aren’t burns. Burn injuries are unique and require specialized treatment.

Dr. Johnson
Dr. Jeffrey Shupp, director, Burn Center

Even burns that appear mild or small can turn into serious injuries without proper treatment. Too often I treat patients whose wounds become infected after non-specialized treatment at a local clinic or wound center – even those that say they treat burns. It’s unfortunate when we have to perform surgery or a skin graft on a patient who may have been healed by now if they had come to a burn center for their initial treatment.

About 486,000 burn injuries require medical treatment in the United States every year – and they can happen to anyone, anywhere, at any age. We treat about 1,000 patients a year, with 600 admitted to the hospital.


When should I go to a burn center for treatment?

 “I don’t want to bother the burn center specialists. It’s just a little burn. They’ll think I’m overreacting.”

I can’t say it enough: You’re not bothering us, and we don’t think you’re overreacting. We’d much rather see you now for a burn that doesn’t require a lot of care, than to later manage an infected wound or perform surgery that could have been avoided.

"Even if you think it’s just a mild burn, go to a burn center." via @MedStarWHC

The American Burn Association has a list of criteria  for which they recommend you receive treatment from a burn center, including:

  • Burns that involve the face, hands, feet, genitalia or major joints
  • Third-degree burns, which can appear whitish, charred or translucent with no pinprick sensation in the burned area
  • Burns that cover more than 10 percent of total body surface area
  •  Electrical or chemical burns
  • If you have pre-existing medical conditions that can complicate recovery

If you have a burn that meets these criteria or that you would like a burn specialist to look at, request an appointment or call 202-877-7347.

What makes a burn center unique?

“I liked the plastic surgeon who performed my surgery last year. Can’t he do a skin graft?”

Surgeons outside of burn centers can perform amazing skin grafts and debridement (removing damaged tissue from a wound). But what makes a burn center unique is the team approach we take to treating burn patients.

Burn center specialists are dedicated to treating only burn patients. They can include:

  • Burn rehabilitation specialists
  • Burn surgeons who have additional training in burn, trauma or critical care
  • Dietitians
  • Nurses with special training in caring for burn patients
  • Pharmacists
  • Social workers

When you’re not treated at a burn center, coordinating care becomes more difficult. You may have surgery at one place and rehabilitation across town. Getting plugged in with a burn center from the beginning makes coordinating downstream care that much easier and can benefit your physical and psychosocial health.

The biggest progress made in burn injury survival did not come from antibiotics or advances in critical care. It was the organization and verification of regional burn centers.

Centers such as The Burn Center at MedStar Washington Hospital Center must meet rigorous criteria to be considered a burn center. There may not always be one right next door. After ours, the next closest burns centers are in Baltimore and Richmond, Va.

D.C. residents are fortunate to have a burn center nearby. For those who do not have a burn center in their community, travel to the nearest burn center for care if you can. I want you to receive appropriate care from the beginning so you can avoid potential complications down the road.

Why burn scars itch and how to find relief

As many as 90 percent of burn patients report itching after their injuries, according to data cited by the Phoenix Society for Burn Survivors. Itching usually subsides over time, but more than 40 percent of one study’s participants reported long-term itching after their initial burn.

Chronic itching on a burn wound is annoying and can be tough to control. But there are treatment methods that have helped relieve our patients’ symptoms at the Burn Center. Let’s discuss why burn wounds itch, available treatments and what our researchers are doing to relieve post-burn itching for future burn patients. 

What causes burn scars to itch?

Itching is known medically as pruritus. Itching often is caused by a substance called histamine. Histamine is a key part of the body’s immune system. It produces many of the symptoms we associate with allergic responses, including swelling, rashes and itchiness.

In this process, your body recognizes some foreign agent — something you’re allergic to, such as pollen or grass — on your skin. That causes your immune system to fight off the invader and release histamine, which causes itching.  

Some itching after a burn is a normal part of the healing process. But itchiness at burn scars isn’t caused by histamine. In this form of itching, nerves misreport an itch on the skin at the burn site, but the irritation actually is coming from the central nervous system. This is a condition known as central itch — basically an internal itch that can’t be scratched. A bigger or more serious burn doesn’t necessarily lead to worse itching at the scar. 

What treatments provide relief for burn scar itching?

The traditional treatment for itchiness is antihistamine. But because central itch isn’t caused by histamine, antihistamine pills and most itch-relief creams won’t always help.  

It may be tempting to scratch an itchy burn wound or scar, but that’s not a good long-term solution. In fact, scratching can damage fragile, healing skin, which is a particular concern for patients who have had skin grafts to treat burns.  

Some of my patients find relief with lidocaine ointment. Lidocaine can temporarily numb the area of skin where it’s applied. Other patients look to alternative treatments to relieve the itch, including:

  • Acupuncture
  • Hypnosis
  • Massage
  • Reiki therapy (a Japanese technique for relaxation and stress relief)  

Many of these alternative therapies help patients focus on something besides the itching. They don’t eliminate the sensation, but it’s not as persistent or top-of-mind as it ordinarily would be.

Some patients can’t find anything that helps with the itch and just live with it. For others, their itchiness comes and goes. There hasn’t been much research on why the symptom varies and what we can do about it — until now.  

If you have itching at a burn site that persists for months or years afterward, talk to your doctor about your treatment options and whether you need a referral to a burn specialist. 

New research into treating burn scar itching

Our early research into burn care focused on emergency care and preventing infections. We’re now turning our attention toward techniques for patients who are living with burn scars after treatment. We’re just starting to get data from patients who have lived with burn scars for 10, 15 or even 20 years. This information will guide our future treatment decisions.  

As of December 2016, we’re enrolling patients in a study to test a medication we could potentially use to treat central itch. We registered the study’s first participant nationwide just before the holidays in 2016, and we’ll be signing up more participants soon.  

We hope to better understand in the coming years why post-burn itching happens and what we can do to stop it. For now, pain-relieving medications and alternative techniques are our best weapons against itchy burn scars. 

Don’t “Feel the Burn” this Summer

Medical Intel Podcast – Dr. Jeffrey Shupp Discusses Summer Burn Prevention

Burns Come in Many Forms

Hear “summer” and “burns” in the same sentence and “sunburn” probably comes to mind.  But that’s not the burn that Dr. Jeffrey Shupp thinks of.

“Between spring and fall, the top reasons for burns are outdoor barbecues, bonfires and fire pits,” says the director of the Burn Center at MedStar Washington Hospital Center, the only adult burn center in the Washington region. “Most cooking accidents involve a fire accelerant, like charcoal lighter fluid, or a backflash from a leaky gas grill or jet that’s been left on too long.”

According to the American Burn Association, gas grill or charcoal fires injure about 6,000 people each year. And while it’s true that being “under the influence” can be a factor, a more common cause is a false sense of security.

“So often we hear patients say: ‘But I’ve always done it this way.’ Unfortunately, those previous, accident-free experiences can lead to a lack of caution…and a second or third degree burn.”

Nowhere is that more apparent than with home fireworks, the second most frequent source of summertime burns at the Hospital Center. Nationwide, almost half of all firework burns affect children. 

“Fireworks can produce very serious injuries, sometimes even requiring amputation of the fingers,” warns Dr. Shupp who, as a six-year-old, was prohibited from ever using sparklers after a napkin caught fire at a family celebration.  

It’s an important warning to heed. The National Fire Protection Association reports that a seemingly innocent sparkler can reach 1,200°F. For perspective, water’s boiling point is 212°F; glass melts at 900°F.

Fortunately, most burns in the United States are first degree—mild injuries to the superficial layer of the skin, like sunburn, that can be safely treated at home.    

But up to 500,000 Americans each year need medical care for more serious burns that can be debilitating and even deadly.

To avoid the emergency room and assure a safe summer for you and your family, follow these simple tips:

  • Wear short sleeves or roll them up when grilling
  • Use long-handled barbecue tools
  • Establish a 3-foot “safety zone” around grills and open fires
  • Be cautious, careful and aware of your surroundings
  • Leave the fireworks in the hands of the professionals

Tune in to the full podcast with Dr. Jeffrey Shupp.
Have any questions?

We are here to help! If you have any questions about burns or the Burn Center call MedStar Washington Hospital Center at 202-877-3627.

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