DermDx: Blister From Heating Pad

Slideshow

  • Slide

A 72-year-old man has experienced persistent pain in his left shoulder and upper arm secondary to pruning shrubs and lifting bags of cattle feed. Approximately 30 years earlier, the patient tore his rotator cuff of the right shoulder, which healed uneventfully following surgical correction. The patient tried oral analgesics for management of the current episode of pain. When that failed, he purchased a portable heating device and applied it to the affected area at the maximal temperature setting (150°F). After 30 minutes, the patient developed a sharp pain at a covered site and discontinued treatment but did not visually inspect the area. The next morning, the patient observed remnants of a blister, reddened underlying skin, and a thin layer of fluid overlying a glistening base.

Thermal burns are commonly classified by depth.1 First-degree burns often present within a localized area and are superficial in nature involving the epidermis. On people with fairer skin, first-degree burns are red in appearance and take on a reddish-brown hue...

Submit your diagnosis to see full explanation.

Thermal burns are commonly classified by depth.1 First-degree burns often present within a localized area and are superficial in nature involving the epidermis. On people with fairer skin, first-degree burns are red in appearance and take on a reddish-brown hue on people with darker skin. Initially painful, full resolution without scarring may be anticipated within 5 to 10 days.

Second-degree burns traverse the epidermis into the upper dermis. Areas are painful, bright red, swollen, and appear shiny and wet. Blister formation is common. Healing without scarring ensues within 3 weeks.

Third-degree and deeper burns, also termed full-thickness burns, destroy both the epidermis and dermis. Sites are not painful because of destruction of nerves. Healing is prolonged and, eventually, hypertrophic scar or cicatricial keloid forms.2

Second-degree burns are usually treated topically with goals including faster resolution and prevention of secondary infection. Occlusion and maintenance of a moist environment have long been recognized as beneficial to healing.3 Over-the-counter antibiotic ointments containing neomycin, polymyxin, and/or bacitracin are commonly used modalities. Aloe vera may also enhance healing time.4

Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.

References

1. Tolles J. Emergency department management of patients with thermal burns. Emerg Med Pract. 2018;20(2):1-24.

2. Yoshino Y, Ohtsuka M, Kawaguchi M, et al; Wound/Burn Guidelines Committee. The wound/burn guidelines – 6: guidelines for the management of burns. J Dermatol. 2016;43(9):989-1010. doi:10.1111/1346-8138.13288

3. Hinman CD, Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963;200:377-378. doi:10.1038/200377a0

4. Sharma S, Alfonso AR, Gordon AJ, Kwong J, Lin LJ, Chiu ES. Second-degree burns and aloe vera: a meta-analysis and systematic review. Adv Skin Wound Care. 2022;35(11):1-9. doi:10.1097/01.ASW.0000875056.29059.78

Next hm-slideshow in Derm DX