Burns, injuries to the skin caused by heat, radiation, electricity, friction, or chemicals, are among the most common and painful injuries. Throughout history, a variety of unusual and sometimes bizarre treatments have been used for burns. One of the earliest documented treatments comes from ancient Egypt, recorded in the Ebers Papyrus around 1500 B.C. This method, which sounds more like a recipe for a potion than a medical treatment, involved combining milk from a woman who had just given birth to a son with a vegetable gum and ram's hair, along with a spoken incantation: "Your son Horus has burned himself in the desert. Is water here? There is no water here. Water is in my mouth, a Nile is between my thighs, I have come to put out the fire. Flow out, burn!"
Well, it’s safe to say they were creative! Over time, other topical concoctions were introduced: the Romans used vinegar and wine, oily mixtures became popular in the 1800s, and tannic and picric acids were used in the early 1900s. Eventually, the use of cold water became a standard acute burn treatment, backed by extensive literature support. Thankfully, no spoken incantations are required in modern medicine.
The use of cold water as a standard treatment for burns has ancient origins. Galen (A.D. 129–199) is often credited as the first to recommend cold water for burns, though no direct reference exists. He also used wine, vinegar, and water compresses for wounds. Later, Arabian physician Rhazes (A.D. 852–923) suggested using rose water cooled with snow to alleviate burn pain. Similarly, Persian physician Avicenna, also known as Ibn Sina, (A.D.980–1037) prescribed ice water for burns. It is believed that the concept of “first aid” was first described by Friedrich Von Esmarch (A.D. 1823–1908), a Prussian surgeon whose teachings focused on bandaging and splinting wounded soldiers.
Many still rely on ancient therapies, believing in their efficacy despite insufficient reliable evidence. Early clinical reports were often anecdotal and poorly controlled, and subsequent animal studies since the 1950s have yielded conflicting results. This is likely due to the use of diverse burn models with differing depths of injury and outcome measures focused on short-term effects.
Burn severity varies: first-degree burns, like sunburns, affect only the epidermis, causing redness, pain, and dryness. These typically heal within a week. Superficial second-degree burns, involving the epidermis and part of the dermis, are marked by clear blisters and weeping skin, healing within two weeks, generally with minimal scarring. Deep second-degree burns and third-degree burns, affecting deeper skin layers and even subcutaneous fat, require more intensive treatment and often result in scarring and the need for skin grafts. Fourth-degree burns are the most severe, extending into muscles and bones. It's important to note that in cases of severe burns, immediate medical attention is crucial.
Managing burns can be complicated, but effective care begins with immediate first aid after injury, leading to better patient outcomes. Numerous regulatory bodies provide guidance on the optimal first aid for burns, typically recommending the application of cool running water for approximately 20 minutes as the primary intervention. The water should be potable and clean, though there are variations in recommended temperature (5-20 degrees Celsius) and flushing duration (10-30 minutes).
Cooling effectively stops burn progression, alleviates pain, and may reduce swelling by stabilizing mast cells and inhibiting histamine release. It also supports faster wound healing by promoting epithelial cell growth. Caution is advised against excessive cooling to prevent hypothermia, particularly in children and the elderly. Using ice or ice water is counterproductive due to resulting vasoconstriction that may worsen burn progression. Some guidelines suggest leaving molten or adherent clothing in place if still attached to the skin. Guidelines universally advise removing burned, wet, or contaminated clothing and any constrictive jewelry. There's a consensus that burn wounds should be covered with a non-adherent dressing post-cooling.
Next comes the discussion of topical agents that are thought to promote healing. Unfortunately, studies have revealed that natural home remedies such as raw egg whites, oil, honey, yogurt, milk, toothpaste, tomato paste, and ice are applied as first aid by individuals worldwide despite the obvious risk of infection they pose. Many of these remedies are non-sterile and can contaminate wounds, and some can form crusts that make wound cleaning painful. Moreover, toothpaste can trap heat and hinder burn healing, potentially causing skin irritation and permanent discoloration.
It is also worth mentioning that these substances can provoke allergic reactions, including anaphylaxis, especially in young children with common food allergies such as milk and eggs. Honey, long used in wound care, shows promise in animal studies and some trials for speeding up superficial burn healing, yet overall evidence remains inconclusive due to study variations in patient types and comparisons. Similarly, aloe vera has been traditionally used to teat burns and is even recommended as a topical agent by regulatory bodies, but clinical evidence remains unclear. Studies vary widely in product types and outcome measures, making definitive conclusions elusive. However, cumulative evidence tentatively supports aloe vera's potential efficacy in healing first to second-degree burns.
In contrast, topical silver sulfadiazine (Silvadene), once a standard treatment for second and third-degree burns, faces limitations. It is contraindicated in patients with sulfa allergies as well as in pregnant and lactating women. Recent evidence suggests other antibiotics may be more effective, prompting a shift away from the widespread use of silver sulfadiazine in burn care.
In the heat of the moment, remember cool running water, clean coverings, and a swift call to medical professionals can make all the difference. So, in case you encounter a burn, think cool, clean, and calm. Leave the toothpaste for your teeth, the eggs for breakfast, and the honey for your tea.
Hosna Akhgary is a BSc candidate at McGill University, majoring in Pharmacology.
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