Facial Burn, Deep Partial Thickness (2nd degree) Healed with Topical Treatment
Elof Eriksson, MD
History:
20 year old woman comes to the ER after sustaining a flame burn to her face 2 hours earlier. She has no other injuries. Her medical history is negative and she takes no medications.
Findings:
20 year old woman who is fully alert and oriented and complains of severe facial pain. She has blisters from the burn over her entire face. The rest of her examination, including her eye examination, was unremarkable.
Fig. 1. Second degree facial burn.
Diagnosis:
Deep partial thickness facial burn (2nd degree) with pronounced blistering.
Differential Diagnoses:
Possibly full thickness burn in small areas.
Workup Required:
A map drawing of the burned areas. Eye and ear examination (the flames were accompanied by a blast) and a general physical examination.
Plan:
Hospital admission for burn treatment and pain control. The burned areas were treated with Silvadene twice daily and residual Silvadene and exudate was removed with moist cotton swabs before each Silvadene application. Pain treatment initially with synthetic opioids and later with ibuprofen.
Expertise Needed:
Plastic or general surgeon experienced in treating burns.
Treatment:
Hospital admission, twice daily Silvadene to the burned areas and pain treatment as needed. When the patient was discharged after 8 days the burned areas were re-epithelialized. She was instructed to use a moisturizing cream at least twice daily and return for follow up in one week.
Follow Up:
4 weeks after the injury, the face was healed with less erythema and minimal early scarring. She was advised to continue using a moisturizing cream twice daily and sunscreen when outside.
6 months later, she was healed with minimal scarring.
Figure 2. Patient healed with minimal scarring
References
Management of patients with facial burns
Topical treatment for facial burns
Surgical excision of the burn wound
https://pubmed.ncbi.nlm.nih.gov/34654517
https://pubmed.ncbi.nlm.nih.gov/32725896
https://pubmed.ncbi.nlm.nih.gov/19793556