Simple cases
Case 56
50-year-old Japanese lady with multiple erosions on face and neck.
History
How can I help you?
I burned myself. I have these spots on my face and neck and I am worried about scarring.
An open question is a good way to start. Often, as in this case, the patient tells you almost all you need to know in just a few words.
When did it happen?
Four days ago.
The time course is crucial for planning therapy.
What happened?
It happened when I was cooking. Hot oil splattered from the pan and caught me on the face, neck and arms.
Notice has the lesions seem to be running down the facea valuable clue that a liquid was responsible.
Did you get blisters?
Yes, a few spots blistered, but they have dried and crusted.
Blisters help you assess the severity of the burn.
Did you treat the burns?
Yes, I immediately applied ice.
Immediate cooling is an important first aid measure for burns.
Have you been in the sun the last few days?
No, I don't go in the sun. Besides, it's been raining for days.
Sun exposure can accelerate post-inflammatory hyperpigmentation, so the patient should avoid sun or religiously use a sunscreen.
Do you take any medications?
No.
Even though we know this is not a drug reaction, the medication history is essential to plan therapy.
Lesion
Choose the right efflorescences:
Correct. She still has some erosionssuperficial skin defects following the burn and blisters.
Bulla are fluid-filled lesions. As the patient told us, the burns did blister, but these lesions are no longer present.
No papules are present.
Some of the lesions have evolved into hyperpigmented macules.
Diagnosis
Choose the right diagnosis:
The history is cleara burn.
Radiation dermatitis is caused by x-rays. It would never be no spotty.
We know that was an accident, but burns can be self-induced.
This is a 2nd degree burn with erythema, blisters, erosions, weeping and crusts. The cause was drops of oil which were splashed onto the skin during cooking. A 2nd degree burn usually heals without scars, but post-inflammatory changes are likely.
Both the history and the examination suggest physically-induced damage.
Therapy
Choose the right therapy(ies):
Too late. The patient did this when the burn occurred.
This burn is not severe enough for hospitalization and fluid replacement. As a rough rule, if more than 10% of the body surface is involved with 2nd degree burns, hospitalization should be considered.
Silver sulfadiazine cream is so beloved in this situation that in some circles it is known as burn butter.
Generous pain relief is a mainstay of all burn therapy.
