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Treatment of keloid scars may be challenging and some patients may need more than one treatment option; others may need to repeat the treatment more than once. The available treatment options may include:

  • Compression garments: the idea behind wearing compression garments is that these garments apply continuous pressure on the keloid scar which will help to flatten and improve the scar appearance. It is important to wear these garments in the early stages of scar formation as the scar will respond better when the compression garments are used since the beginning were the scar is still fresh and immature. Compression garments should not be loose and should be worn for 23 hours a day and taken only when bathing and during dressing change. Burned patients may be asked to wear the garments for years. Ask your treating physician for how long you should wear them.
  • Surgery: surgical removal of keloids was traditionally recommended however, there is a high incidence of recurrence of the keloid scar (50%-100%) if surgery is not combined with other modalities of treatment. The recurrent keloid may be larger and more severe than the original one that was present. Surgical removal is done by excising the keloid and suturing the area to help close the wound or using skin graft is the area is big combined with another method such as silicone gel.
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After a burn injury, the body tries to repair and heal the damaged skin by forming new tissue as part of the natural healing process. Collagen which is an important structural protein plays an important role in the healing process (Di Lullo et al, 2002). Collagen accumulates around the damaged area and builds up to help the wound seal the area. Usually there is a balance between the production and the breakdown of collagen.

The healing process can cause a scar to appear which usually fades away over time by becoming smoother and less noticeable. When the scar continue to grow and invade the healthy surrounding skin, it will form what is called a keloid. Keloid scars are bigger than the original wound that was created by the burn injury. They are usually higher than the normal surrounding skin, hairless and shiny, and can feel rubbery to touch.

Keloids can affect anyone but, certain people are more predisposed to form keloids more than others such as African, African-Caribbean and south Indian communities (Dark skin people tend to get keloids easier than fair skin people). More than 50 percent of patients with keloid scarring have a positive family history of keloids (Bayat et al 2005). The bigger and the deeper the burn is (reaching the dermis), the more are the chances of forming a keloid scar. It is hard to tell how much the patient will scar after a burn injury; most second and third degree burns will cause some degree of scaring.

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Burn injuries can be very traumatic and painful and may take a long time to recover. Many complications can happen as a result of the burn injury including infection, scaring, disfigurement, contractures, reduced or limited mobility, loss of function, muscle, ligament, or nerve damage, mental and psychological trauma, amputation of a limb and even death in severe cases.

The more severe the burn is (second and third degree), the more damage to the body it creates. Burn injuries may need extended periods of hospital stay as well as prolong care and a lot of follow ups for rehabilitation after hospital discharge. Some burn victims may need services such as physical therapy, occupational therapy, psychiatric counselling, plastic or cosmetic surgery; all these may create an extra burden on the patient mentally, physically and psychologically.

Some burned victims may lose their homes and all their belongings as a result of the fire. Families and caretakers of a burned patient may also be traumatized and need help in dealing with the impact of the trauma.

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Burn injuries whether it is first degree, second degree or third degree are very common and can happen to anyone; they can be devastating and life changing. It is estimated that 11 million burned patients worldwide needed medical attention in 2004 and about 300,000 patients died as a result of that (Peck, 2011). In the US more than 300 children ranging between the ages of 0-19 years are treated in the emergency room on a daily bases as a result of injuries related to burns and 2 children die as a result of their burns (CDC Data, 2012).

The most common complication of burn, is infection (Herndon, 2012). Signs and symptoms of infection may include; fever, foul smelling discharge from the area, increased redness in the surrounding area of the burn, increased swelling in the area and increased tenderness (pain) in the area. It’s very important to look for signs and symptoms of infection and contact your care provider right away if you notice any of the above symptoms.

It is important to keep your burns clean to avoid infection. When bathing the burn area, the first thing to do before getting into the shower or tub is to test the temperature of the water as the burned and new skin is sensitive to extreme cold or extreme hot water and can be injured easily. To avoid hot water burns and scalds, set the thermostat on your hot water heater to below 120 degree Fahrenheit (48.9 C).

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Facial burns can be very serious depending on the severity and the extent of the area involved. Facial burns can affect the epidermis, which is the first layer of the skin or can be deeper, affecting the dermis which is the second layer of the skin. From 2009-2013, more than 200,000 Emergency Department visits were nationally reported as a result of burns to the head and neck (Heilbronn et al, 2015).

Facial burns affecting the Epidermis can happen as a result of severe sunburns as well flash burns resulting from various explosions. These burns may be associated with pain, redness and swelling of the face (oedema); they usually heal without leaving a scar on the face.

Deeper burns affecting the Epidermis and the Dermis may result from thermal, chemical, electrical injuries or flash burns from gas explosion. These burns may be associated with swelling of the face and pain, but when they are deep enough affecting the nerve endings which convey pain sensation these burns can be less painful. Usually deep burns leave scarring on the face when they heal.

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One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.

Clinical features of scald burns:

Clinical features of scald burns depend on the severity of burn whether it’s a first,second or third degree burn. Clinical features may include:

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Hot water scalds can cause severe burn injuries leading to lengthy hospital stay that may result in scaring and permanent disfigurement or even death. As the majority of these scalds injuries happen at home it’s important to follow certian measures that may prevent these types of burn injuries which are common in elderly, young children and people with disabilities.

Prevention of tap water scald injuries may include:

  • Setting water heater thermostats at a temperature not higher than 120°F (49°C), the safest water to bathe is about 100°F (37°C)
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One of the most common causes of burn injuries is scald injury. Hot water scalds is a common cause of scald injury in which a short exposure time can result in severe burns depending on the water temperature. Most scald burns happen in the home from exposure to hot water in the sink, showers or bathtubs. Scald burns can also happen at restaurants and other places. Scald burns can happen to anyone, the severity depends on the temperature of the liquid and the duration of exposure.

Scald burns can happen to anyone but there is a vulnerable population which can be affected that includes young children, elderly people and people with disabilities. Many people are unaware that it needs a short exposure period to hot tap water to cause serious burns. People at high risk of developing scald burns are:

  • Young children have thinner skin, this results in deeper and more severe burns. Children have greater body proportion that is exposed to a scalding substance.
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The skin is the first line of defense against infection, it is composed of three layers, the epidermis, the dermis and the subcutaneous tissue layer (see the skin). Infection is the leading cause of death among hospitalized patients with burns. Normally the surface of the skin contains a mixture of microorganisms called normal skin flora, these flora live on the surface of skin and cause no disease unless the skin is damaged and/or the immune system is compromised. (see wound infection)

Cellulitis is an infection of the dermis and the subcutaneous tissue layer of the skin, cellulitis can be caused by normal skin flora or by exogenous bacteria, where in most cases the skin has previously been broken such as:

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