How should you handle a client with a burn on her skin?
During the winter season, your clients may be more prone to burning themselves by accident, perhaps while heating up some soup on the stove or lighting a fireplace. And during the summer, your clients may accidentally burn a hand near a bonfire or heating a barbecue. The extent of damage depends on the type of burn, but your client’s skin, tissues or even fat layers may be compromised. To get a better idea of your client’s situation, you need to understand that skin is made up of three layers: the epidermis on top; the dermis layer directly under the epidermis; and the bottom layer is the subcutaneous tissue, according to the U.S. National Library of Medicine and the National Institutes of Health. “A burn due to thermal injury kills the epidermal, dermal or subcutaneous cells, resulting in death of these cells,” explains Robin Ashinoff, MD, director of dermatology at Mohs, and Laser Surgery at Hackensack University Medical Center in Hackensack, New Jersey. This cellular change necessitates aftercare and may result in long-term issues, such as scarring. In this month’s Nail Clinic, we delve into the science of burns, as well as the precautions that you and your clients should take to ensure fast and safe healing.
The most common burns often fall into two categories: thermal burns, which are caused by heat, such as fire or hot liquids; and chemical burns, caused by “caustic substances” that harm the skin, such as lye or even wet cement, according to The Merck Manual of Medical Information. Other less common types of burns include those caused by sunlight, radiation or electricity.
Burns are further classified into first-degree, second-degree and third-degree burns. “Burns are classified based on the depth of tissue damage,” says Ali Hendi, MD, board-certified dermatologist and Mohs surgeon based in Chevy Chase, Maryland. He outlines the differences between the types of burns:
- First-degree burns are limited to the epidermis, usually causing redness and minimal swelling of the skin
- Second-degree burns, also known as “partial thickness burns,” are limited to the epidermis and dermis; redness, swelling and blisters may be present
- Third-degree burns, also known as “full thickness burns,” are the most serious; they involve all three layers of the skin—epidermis, dermis and subcutaneous layer—and occasionally muscle and bone. These often require skin grafts and can be life-threatening, so they need immediate medical attention
When a burn occurs, a person should act quickly to help reduce the severity of the injury. To quell the symptoms and pain of a minor burn, rinse the skin to prevent infection and apply a cold compress. “Cool the burn with cool water. Apply ice for five minutes on [the skin] and two minutes off [the skin]. [Repeat these steps] for one hour,” Hendi recommends. “This will decrease swelling, which can cause pain. Depending on the location or percentage of surface area burned, emergency room evaluation may be needed.”
Indeed, many medical professionals recommend a doctor’s visit for all burns, except for minor ones. “If someone gets burned, immediate cold is best,” agrees Ashinoff. “But then see a physician to be sure of the damage, especially with burns on the hands, which could get infected or scar.”
Once the proper steps have been taken to care for a burn, then the healing process can begin. Healing time varies according to the person and the severity of the burn, Hendi notes, as well as other factors, including location, degree of burn, age and any other medical conditions (such as diabetes) that may be present. “Burns on the hands tend to heal faster than those on the feet,” he relates. “A first-degree burn on the hands may heal in as fast as one to two weeks. Generally, burns or wounds closer to the heart heal faster.”
The signs of burns may also stick around even after the healing process is complete. “Burns can leave dark or hyperpigmented marks on the skin, particularly in darker-pigmented individuals,” Hendi says. “Sun avoidance minimizes this. However, if the dark spot persists, prescription bleaching creams can help.”
There are obviously many complications with skin that has suffered a burn. So how should you handle a client who has a burn? Experts agree that nail technicians should refrain from working on skin that shows signs of damage. “I would recommend that no nail products be applied and no esthetic services be rendered on anyone with a burn that has not totally healed,” says Ashinoff. Many clients who suffer a burn will also exhibit blisters on the skin. “If there is a blister in place, it should not be opened or drained,” Hendi says.
Refusing to work on a client with a burn is the only way to ensure that you don’t worsen the problem. “Burned skin doesn’t have the same barrier function as normal skin, and chemicals or irritants, such as perfumes or preservatives in skincare creams or lotions, can cause irritation and should be avoided,” Hendi emphasizes.
Experienced nail techs also suggest that salon employees avoid handling or working on any skin that has been recently burned. “I know how extremely painful a burn can be to the touch,” says Lynette Guzman, 19-year veteran nail technician from Huron Township, Michigan. “Therefore, I would not recommend doing any service on the client until it completely heals, for fear of infection.” Erring on the side of caution will protect your license and your livelihood.
With the proper care after a burn—and the proper avoidance of the burn by nail professionals—further harm can be avoided. To make sure your salon doesn’t get badly burned by a case that implicates you in worsening a client’s wound, advise the client to allow the skin to heal before you commence your regular appointments.
- More than 2 million people in the United States require treatment for burns each year
- Between 3,000 and 4,000 people die of severe burns each year
- Burns that involve more than 90% of the body surface, or more than 60% in an older person, are often fatal
- At least 50% of all burn accidents can be prevented
- From ages 5 to 74, most burn injuries occur outdoors, with the next most frequent area being the kitchen
*Sources: The Merck Manual of Medical Information, Burn Survivor Resource Center
The Post-Burn Diet
The link between nutrition and skin has been proven by scores of research, so it makes sense that diet can have an impact on helping skin heal after a burn. According to the Burn Survivor Resource Center, a diet that includes the basic components of protein, carbohydrates and fats with added minerals is instrumental during this time. The body can break down carbohydrates to create glucose, which is necessary for healing. The Center reports, “Common recommendations include getting 30% of calories as fat, though this can be higher if needed. However, excess fat intake has been implicated in decreased immune function, and intake levels should be monitored carefully.” Helpful vitamins include vitamins C and E, as well as zinc, which “may limit oxidative damage and promote wound healing.” Suggest to your client that she consult with her doctor about nutritional guidelines before she hits the road to recovery.
– Tracy Morin
Image: Phil Dention via Flickr under Creative Commons license (cropped)