Managing itchy skin after a burn injury

Itchiness in and around wounds after a burn injury is very common. Frequent itching can affect your child’s daily activities and also stop them from sleeping well at night. For these reasons it can be quite distressing.

Scratching the itch can also cause healed burns, skin grafts and donor sites to breakdown because skin can be fragile in these areas. If not well controlled this itch can become a prolonged symptom after the burn has healed.

What can we do about my child’s itching?

The following treatments can be effective in dealing with itchiness. The burns team will work with you until your child’s itch is under control.

Itch scale

To monitor how well the treatment is working we encourage children to monitor their itch using the itchy scale.

Itch score

0. Comfortable and no itch
1. Itches a little but does not interfere with activity
2. Itches more and sometimes interferes with activity
3. Itches a lot and is difficult to stay still or concentrate
4. Itches a lot and is impossible to stay still or concentrate

How to use the itch score

1. Ask your child how itchy they are feeling from the itchy scale.
2. Make a note of this, even if score is 0.
3. Provide treatment as prescribed, such as medicine, cream, pressure garment and so on.
4. Ask your child to rate their itch again after 1 hour, and make a note of it again. If it has not improved then try a different treatment.

For example:

Telling these scores to the burns team will help us to determine if the treatment is working.

If your child is scoring 0s and 1s, then they are fine to continue with medicine and cream.

If your child is scoring 1s and 2s several times in 24 hours, then let the burns team know.

If your child is scoring 3s and 4s more than 2 or 3 times in 24 hours then let the burns team know immediately.

Medication

In an unhealed burn wound, we prescribe medicine to help control the itch sensation.

Taking medication can be effective for some children. The medication your child needs will be given to you by the burns team. It is important to take it as directed by the burns team or pharmacist.

If the itch is only mild or occasional, or you are waiting for your next appointment, then you can give your child chlorphenamine (Piriton) which is available in chemists and supermarkets. Please follow the instructions on the bottle.

Moisturising and massaging

If the wound is healed then moisturising and massage can help.

1. Wash the affected area once a day with a non scented soap.
2. Pat the area dry with a clean towel and apply a non-scented moisturiser.
3. Apply the moisturiser as often as required to stop the healed area becoming dry, it should be applied a minimum of 3 times a day.
4. When applying moisturiser, use gentle pressure with your index and middle finger to press the area firmly for 30 seconds. When the scar changes colour, from pink to white you are pressing with the correct pressure. This must be done at least 3 times per day. This technique was shown to you by the burns team. Make sure you do not rub or drag the skin as this may cause damage.

If you have been fitted with pressure garments apply after washing and creaming.

Try storing your moisturising cream in the fridge, the coolness can help with the itch.

Creating the right environment

Wearing cool cotton clothing over the affected area has been found to be helpful. Use cotton bedding and avoid nylon and wool clothing as they can irritate the skin. Make sure all clothing and bedding is washed, preferably using a non biological detergent.

Try to make sure that the room your child is in is kept cool.

Place a hand towel in a plastic bag and then put it in the fridge. When your child is feeling itchy, take the towel and place it over the affected area. Do not use ice directly on the skin as this can cause further damage.

If these treatments are not effective and your child is still itchy then please speak to the burns team at your next appointment.