Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take. Call anytime you think you may need emergency care. For example, call if:. Call your doctor or nurse call line now or seek immediate medical care if:. Watch closely for changes in your health, and be sure to contact your doctor or nurse call line if:.
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Important Phone Numbers. Topic Contents Your Recovery How can you care for yourself at home? When should you call for help? Where can you learn more? Top of the page. Your Recovery Skin grafts are thin sheets of healthy skin removed from one part of the body donor site and put on another part.
How can you care for yourself at home? Rest when you feel tired. Getting enough sleep will help you recover. Try to walk each day, unless the grafted area is on your foot or leg. Start by walking a little more than you did the day before.
Bit by bit, increase the amount you walk. Walking boosts blood flow to the skin grafts. Ask your doctor when you can drive again. Your doctor will tell you when you can return to work. It depends on the size of the skin graft, what part of your body was grafted, the type of work you do, and how you feel. Your doctor will tell you when you can take a shower. Do not take a bath for the first 2 weeks, or until your doctor tells you it is okay. Pruritus is a frequently encountered symptom following burns.
Higher intensity of itching has been associated with depth of the wounds and specific body locations but these differences are not well understood. Our aim was to investigate the intensity of post burn pruritus in grafted and non-grafted burns across anatomic areas and to report on itch-inducing factors and applied treatments.
The study included patients prospectively followed for 18 months. Results showed that grafted patients and non-grafted patients reported similar overall itch intensity in-hospital. At 3 months post burn, grafted patients had higher overall itch scores, a difference that was found robust across the study period. Grafted wounds were found to produce higher mean itch intensity at 3 months post burn but this difference disappeared at 12 months post burn.
Differences in itch prevalence rates were found across anatomic areas, but only in non-grafted burns. The differences in itch intensity on patient level versus wound level suggest that on the longer run, peripheral mechanism do not explain the higher itch scores in grafted patients.
Key words: itch; pruritus; burns; scars; skin grafting. Accepted Sep 1, ; Epub ahead of print Sep 2, E-mail: h. A substantial proportion of the patients with burns suffer from pruritus and this has been shown to interfere with sleep and daily activities 1, 2. The symptom often presents when re-epithelialisation takes place and may persist for years 3—6. Within the first years post burn, a significant reduction in the intensity of pruritus was found 3, 5, 7.
Burn severity has been found to play an important role in burn-related itching. The number of surgeries and total burned surface area were identified as risk factors of pruritus at 3 months post injury 3, 5, 8 as well as on the long term 3, 4, 6, 9. In particular grafted wound sites seem to cause higher itch intensity, painful and paresthetic sensations 4 , and elevated sensory thresholds or absent responses to various physical stimuli 10, Related to depth of the wound, patients with dry skin and hypertrophic scars were more likely to report itch, up to 24 months post burn 3.
Furthermore, some studies found pruritus to be related to the anatomic location. The legs 8, 9 and the trunk 9 showing to be the most predisposed locations to the development of itch, whereas the face was the least susceptible location to high itching 8. These findings suggest peripheral differences across wounds in the generation of pruritic impulses. Histamine is the best known mediator for the induction of itch. It is present in mast cells, which release their content upon activation.
Histamine has been shown to increase collagen production by fibroblasts 12 and may explain why itchy scars are more hypertrophic. Besides an increase in collagen content, hypertrophic scars are also characterised by prolonged inflammation and associated with an adverse environment for sensory structures to recover.
The subsequent reduction in skin fibre density may account for the aforementioned elevated sensory thresholds 10, Higher itch intensity across different body parts may also suggest a role of nerve density in itch. Previous research has shown that the density of epidermal free nerve endings differs across the body 13 and that nerve fibre density may be correlated to pruritic sensations Thus, it is now assumed that both an increase of mediators and neuronal damage caused by deep dermal burns, contribute to the pruritic symptoms Although the evidence for involvement of the central nervous system in itch perception can not be ignored 16 , all these studies suggest that processes at the skin level may have a role in itching but few studies investigated itch at body location level and investigated more thoroughly the role of skin grafting.
Along with the lack of understanding of underlying mechanisms, the management of post burn pruritus has been shown to be extremely challenging 15, Currently, emollients and systemic antihistamines are the leading therapy.
These treatment modalities provide relief in a substantial group of patients but mostly no complete resolution of symptoms can be accomplished. Several treatment options are now available with varying efficacy. Centrally acting pharmacological agents include opioid agonists and antagonists 18 , and antidepressants Emerging clinical evidence appears to tentatively support gabapentin 20 and pregabalin Non-pharmacological treatment consists of pressure garments, silicone gel treatments, laser therapy 22 , massage therapy 23 and transcutaneous electrical nerve stimulation However, a clear consensus on the care of patients with post burn itch is lacking.
Little evidence is available on a potential correlation between successful therapy and depth of the wounds. Studies shedding light on characteristics of itch and inducing factors may identify subgroups of patients with different needs and thus help clinicians to tailor interventions.
The objective of this prospective cohort study is to focus on differences between grafted and non-grafted areas and to examine possible differences across anatomic locations. We hypothesise that grafted wounds produce higher itch intensity and that the itch intensity is depending on the affected body location. Furthermore, a description of itch-inducing factors and pharmacological and non-pharmacological interventions is provided. The study was approved by the ethics committee of the Martini Hospital, Groningen, The Netherlands, and featured a prospective longitudinal cohort design using a self-report questionnaire.
As part of a larger study, participants were consecutive admissions from 5 regional burn centres in the Netherlands and Belgium between January and January Patients were excluded from the survey if the injury was the result of a suicide attempt, or if they suffered from cognitive disorders that prevented reliable data collection. All patients who gave their written informed consent completed the questionnaire in the week before discharge, and at 3, 12, and 18 months following their injury.
Patients who did not return the questionnaire within 2 weeks were contacted with the request to return the questionnaires. No further efforts were taken to increase the response rate. For the purpose of this study we used the information on overall itch intensity and itch intensity across anatomic locations rated on a point scale.
The distinction between grafted and non-grafted areas was recorded from the medical files before discharge from the hospital. The nerve fibers responsible for the itch sensation have their endings right at the junction between the two layers of skin, the dermis, and the epidermis. These nerve fibers are identical to those that conduct pain messages. So, in truth, itching is a variant of pain. The first step in treating itching is keeping the skin moist.
Dry skin, especially dry burned skin, is a common cause of itching. This problem can be easily prevented by applying skin moisturizers on a regular basis, often several times a day. We use creams that are simple in composition, avoiding those with perfumes or other additives. Lotions should also be avoided because they contain alcohol to liquefy them, and alcohol can dry the skin.
Vitamin E, aloe vera, and other natural ingredients are not helpful in my experience, but neither are they harmful although they significantly increase the price of the moisturizing cream! Cocoa butter is one of my favorites, especially the solid stick form. Crisco shortening in the tub, not the oil is also very effective.
The second step is ensuring that pressure garments are applied appropriately by a professional. Many burn centers advocate pressure garments to minimize scar formation, but in addition, they can also provide relief of local symptoms of discomfort in the burn scars.
By squeezing the scars and reducing the amount of blood in the vessels and fluid in the tissue, pressure garments can make burn scars, especially on the extremities, easier to live with. Some of our patients continue to use their garments, particularly on the legs, long past the time when the scars are mature and no longer thickening.
Stay connected with Phoenix Society and the burn community by signing up for our monthly newsletter. Topical medications are helpful in some patients.
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