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Burn area color changes after superficial burns in childhood: can they be predicted?
T M de Chalain1, C Tang, H G Thomson
1Division of Plastic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Predicting burn wound pigmentation is challenging. Hyperpigmentation of burn sites in children, especially those with darker skin tones, increases over time if the deep dermis remains intact.
Area of Science:
- Dermatology
- Burn Scar Research
- Skin Pigmentation Studies
Background:
- Superficial burn injuries often result in unpredictable post-injury pigmentation changes.
- Accurate prediction of burn wound color alteration is clinically significant for patient management.
Purpose of the Study:
- To identify clinical indicators for predictable color changes in pediatric burn wounds.
- To investigate the correlation between skin type, time post-injury, and burn site pigmentation.
Main Methods:
- Retrospective analysis of 50 children with superficial partial-thickness burns.
- Skin color assessment using the Fitzpatrick scale (1-6).
- Spectrophotometric measurement of burn site and control skin reflectance and luminance.
Main Results:
- Burn site color changes were variable within the first 3 years post-injury.
- Cumulative hyperpigmentation occurred after 3 years in burns where the deep dermis was preserved.
- Hyperpigmentation significantly correlated with Fitzpatrick skin type (p < 0.01) and time post-injury (p < 0.05).
Conclusions:
- Post-burn hyperpigmentation is a cumulative process influenced by initial skin type and time elapsed since injury.
- The Fitzpatrick scale and spectrophotometry are valuable tools for quantifying burn scar pigmentation.
- Melanocyte presence in the deep dermis is crucial for developing hyperpigmentation post-burn.
Abstract:
Pigmentation changes after superficial burn injuries are often difficult to predict. We analyzed a sample of patients with burn injuries, looking for clinical indicators of predictable color changes in burn wounds. A sample of 50 children, predominantly those with pigmented skins, who had sustained superficial partial-thickness, (second degree) thermal, scald, or friction burns, were retrospectively grouped. Chemical and electric burns, and those needing skin grafts were excluded. Forty-one patients returned for interview and examination, an average of 63 months after injury (range, 3 to 276 months). All patients had their skin color graded in terms of the Fitzpatrick scale--a numeric scale that combines innate skin color plus reported history of skin response to sun exposure, to assign a value from 1 to 6, where white skin that reddens but does not tan on sun exposure is 1 and heavily pigmented black skin is 6. The burn site, as well as unburned areas of control skin, were tested for reflectance and luminance with use of a well-validated spectrophotometric technique. As an addendum, clinical photographs of a further 50 patients were similarly analyzed. During the first 3 years after injury, burn site color changes were variable. Subsequently, there was cumulative hyperpigmentation at the burn site, provided that the melanocyte-bearing deep dermis had not been destroyed. Hyperpigmentation correlated significantly with skin color, as quantified by the Fitzpatrick scale (p < 0.01), and with time after injury (p < 0.05).