- CONDITION CENTERS
When cuts, scratches, and burns demand quick treatment, the pharmacist can identify the best products and procedures to promote healing and prevent infection.
Pharmacists often encounter patients seeking guidance in selecting nonprescription products for the management and treatment of minor wounds and burns. Proper wound care is essential to the healing process and can reduce or prevent the possibility of scar formation and secondary bacterial skin infections.1 Wound healing begins immediately after an injury occurs; the 3 phases of the healing process are the inflammatory, proliferative, and maturation (remodeling) phases.1
Currently, a host of nonprescription first aid products are available for the self-treatment of minor wounds, such as scrapes, scratches, cuts, and burns. Pharmacists can provide guidance on the selection and proper use of these products. They can also ascertain the appropriateness of self-treatment and refer patients to seek medical care from their primary health care provider when self-care is not deemed appropriate.
Because certain pharmacologic agents or medical conditions can hinder or impair healing, pharmacists should remind patients about the importance of adhering to proper wound care protocols for minor wound care and encourage them to seek the advice of their primary care provider if needed.
Classification of Wounds and Burns
Both the type and severity of a wound or burn are critical in deciding the best care protocol. Typically, wounds are classified according to their acuity and depth.1 Common types of acute wounds include abrasions, punctures, and lacerations.1 Abrasions involve an injury of the epidermal portion of the skin, typically caused by rubbing or friction.1,2 Punctures occur when a sharp object has pierced the epidermal layer and lodged into the dermis or deeper tissues,1 and lacerations are caused by sharp objects that have pierced several layers of skin.1,2
In general, if acute wounds such as abrasions or puncture wounds do not extend beyond the dermis, self-care is warranted.1 Patients with chronic wounds should always be advised to immediately seek medical attention for proper wound care to prevent further complications, such as infection.
With regard to burns, superficial burns—along with some superficial partial-thickness burn injuries—are the only types of burns that are suitable for self-treatment.1 Individuals with deeper burns should always be referred for medical evaluation.
Treating Minor Wounds and Burns
The overall goals of wound and burn treatment are to promote healing, prevent infection or further complications, provide physical protection, and minimize the effects of scarring.1
OTC products currently on the market for self-treatment of wounds include topical antibiotics (eg, bacitracin, neomycin, and polymixin B sulfate), wound irrigants, wound antiseptics, various types of bandages including medicated bandages with topical antibiotics, and products that help reduce the appearance of scars. Bandages are available in waterproof form, liquid bandage form, and in latex-free form for those with allergies.
Nonprescription products available for minor burns include skin protectants, skin protectants with and without antiseptics, and local anesthetics. In some cases, patients experiencing pain associated with a minor burn may benefit from taking OTC nonsteroidal anti-inflammatory drugs or acetaminophen on a short-term basis if appropriate and if no contraindications are present.7
Wound Irrigants and First Aid Antiseptics
Wound irrigation may be warranted to clean the wound surface if dirt or debris is present.1 In this case, a normal saline solution or a mild soap and water can be used. In addition, topical antiseptics can be used to disinfect the skin, but should only be applied to intact skin up to the edges of the wound.1
Examples of first aid antiseptics include ethyl alcohol (48%-95%), isopropyl alcohol (50%-91.3%), iodine topical solution USP, iodine tincture USP, povidone-iodine complex (5%-10%), camphorated phenol, quaternary ammonium compounds, and topical hydrogen peroxide solution (0.13%).1
Topical First Aid Antibiotics
Topical OTC antibiotics are indicated for the prevention of infection in minor cuts, wounds, scrapes, and burns. They should be applied after a wound has been cleansed, and prior to the application of a sterile dressing.1 Band-Aid (Johnson & Johnson) offers a medicated bandage product that contains a topical antibiotic for added convenience. Neosporin ointment (Johnson & Johnson) is available in a small, portable container or in a single-use dosage form.
Skin protectants such as allantoin and white petrolatum are recognized by the FDA as safe and effective for the temporary protection of minor burns and provide only symptomatic relief.3 Skin protectants can shield burns from mechanical irritation caused by friction, prevent the drying of the stratum corneum, and minimize the pain associated with minor burns.3
Topical anesthetics, which can help relieve pain associated with minor burns, work by inhibiting the transmission of signals from pain receptors. These products are typically applied no more than 3 to 4 times a day as needed.3 The 2 most common topical anesthetics found in nonprescription products include benzocaine, in strengths of 5% to 20%, and lidocaine (0.5%-4%).3
For wounds and burns to heal properly, proper care is essential. Studies have shown that with uncovered wounds, there are increased risks of scarring, possible infection, and reinjury. Covering the wound to create a moist healing environment is now considered the standard of care, because it appears to accelerate healing and may minimize scaring and reduce incidence of infection.1,4,5
Typically, dressings should be changed every 3 to 5 days unless otherwise directed, as frequent dressing changes may remove resurfacing epithelial layers and may hinder or slow down the healing process.1,4,5 Patients should be counseled to continue using dressings until the wound shows signs of healing, and should always be advised to seek medical care for wounds that do not exhibit any signs of healing after 5 days of self-treatment, or wounds that show signs of infection.
Patients should be reminded that using ice on burns should be avoided, because it may cause vasoconstriction to the area and make the burn worse.3,6 If a burn does not show signs of healing or appears to worsen or show signs of infection after 7 days of treatment, patients should be advised to seek further medical care.3 During counseling, pharmacists can also suggest that patients have a first aid kit handy in case of emergencies, and be sure to routinely check that the items in the kit are not expired. Patients can either purchase first aid kits that already include the essential items, or assemble their own kits.
The American Red Cross Web site includes first aid tips and lists the 10 most common first aid myths. To access the site, go to www.redcross.org/email/safetynet/v1n9/firstaid.asp.
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
1. Benard D. Minor wounds and secondary bacterial infections. In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC: American Pharmacists Association; 2009:759-773.
2. Lacerations. Merck Manual for Healthcare Professionals Online. www.merckmanuals.com/professional/sec22/ch328/ch328a.html#v1110280. Accessed July 18, 2011.
3. Prince V. Minor burns and sunburns. In: Berardi R, Newton G, McDermott JH, et al, eds. Handbook of Nonprescription Drugs. 16th ed. Washington, DC: American Pharmacists Association; 2009:745-758.
4. Proper wound care: clean, treat, protect. Band Aid Web site. www.bandaid.com/proper-wound-care/clean-treat-protect. Accessed July 18, 2011.
5. Neosporin Web site. www.neosporin.com/firstaid/pdf/sciencefactsheet.pdf. Accessed July 18, 2011.
6. Basic burn care/first aid burn treatment. Massachusetts General Hospital Web site. www2.massgeneral.org/burns/patients/. Accessed July 20, 2011.