Managing Burn Treatment: Concerns for Diabetic Patients

Burn treatment medications

Hello Doctor, on July 12, I had a car accident and fell, causing the exhaust pipe to burn my right inner ankle, resulting in a burn area of approximately 7x10 cm, with second-degree to third-degree burns.
I am also a diabetic patient, so I am a bit worried about the wound.
So far, the doctor has prescribed me "Silvadene cream," but since July 20, every time I apply it, I experience burning, stinging, and itching, and the surrounding nerves also hurt.
Taking painkillers has not been effective, and the pain lasts for about 2 hours before subsiding.
Using this cream seems to cause more yellow exudate.
Due to the intense pain, I have used "Lifewave ointment" for a few days, which does not cause pain and has less yellow exudate.
When I returned for a follow-up, I informed my doctor about my condition after using the medication, but he only prescribed more painkillers, which honestly have not helped at all.
Is it normal to experience these side effects from the medications? Can I continue using the ointment? Please help me with these questions.
Thank you.

Miss Lin, 30~39 year old female. Ask Date: 2023/07/25

Dr. Li Zhonghuai reply Surgery

Hello! "Using this ointment tends to produce yellow exudate": this is necrotic tissue, which needs to be removed each time the dressing is changed.
If possible, it is recommended to change the dressing three times a day.
The tissue damage caused by burns is ongoing, and burn ointment is used to remove necrotic tissue; emollient ointments do not have this effect.
Necrotic tissue accumulating on the surface will only worsen the wound, and it can prolong cellulitis, causing more pain, especially since you have diabetes, which makes healing more difficult.
I recommend: 1.
Change the burn ointment three times a day, ensuring that necrotic tissue is removed each time; you may visit a clinic for dressing changes.
2.
Pain relief can be enhanced with analgesics and muscle relaxants, and you may add vitamin B12.
3.
For itching, antihistamines can be taken.
4.
Maintain good blood sugar control, and avoid smoking and alcohol.
Take care! Changhua Hospital is concerned about you!

Reply Date: 2023/07/25

More Info

Managing burn treatment in diabetic patients requires careful consideration due to the unique challenges posed by diabetes. Diabetic patients are at a higher risk for complications such as delayed wound healing, infections, and neuropathy, which can complicate the management of burns.
In your case, you have sustained a second to third-degree burn on your right ankle, and you are experiencing significant pain and discomfort from the medications prescribed. The use of "使立復藥膏" (likely a topical medication for burn treatment) has resulted in burning, stinging, and itching sensations, which can be distressing. It is essential to understand that while some topical treatments can cause irritation, the severity of your reaction may indicate that this particular medication is not suitable for your situation.

Understanding the Pain and Discomfort
1. Topical Medication Reactions: The burning and stinging sensations you are experiencing could be due to several factors, including the formulation of the medication, the condition of your wound, or even an allergic reaction. In some cases, burn ointments can cause irritation, especially if the skin is sensitive or if there is an underlying infection.

2. Yellow Exudate: The presence of yellow tissue fluid (exudate) can indicate that your wound is healing, but it can also suggest the possibility of infection. In diabetic patients, the risk of infection is heightened, and any signs of increased drainage or changes in the wound's appearance should be closely monitored.

Recommendations for Management
1. Consult Your Physician: Given your ongoing pain and the ineffectiveness of the prescribed pain medication, it is crucial to communicate these concerns with your healthcare provider. They may need to reassess your treatment plan, consider alternative topical agents, or investigate the possibility of infection.

2. Alternative Topical Treatments: If "使立復藥膏" is causing significant discomfort, you might consider discussing the use of "利膚軟膏" (which seems to provide you with relief) with your doctor. It is essential to ensure that any alternative treatment is appropriate for your burn type and stage of healing.

3. Pain Management: If the prescribed pain medications are not effective, your doctor may consider adjusting the dosage or trying different analgesics. Pain management is crucial, especially in diabetic patients, as uncontrolled pain can impede healing.

4. Wound Care: Proper wound care is vital for diabetic patients. Ensure that the burn area is kept clean and protected. Regular dressing changes and monitoring for signs of infection (increased redness, swelling, warmth, or pus) are essential.

5. Blood Sugar Control: Maintaining good glycemic control is critical for wound healing. High blood sugar levels can impair the body's ability to heal and increase the risk of infection. Regular monitoring and management of your diabetes will support the healing process.

6. Follow-Up Care: Regular follow-up appointments with your healthcare provider are essential to monitor the healing progress of your burn and to make any necessary adjustments to your treatment plan.

Conclusion
In summary, managing burns in diabetic patients requires a comprehensive approach that considers the unique challenges posed by diabetes. Your symptoms of pain and discomfort with the current medication warrant a reevaluation by your healthcare provider. Open communication about your experiences and concerns will help ensure that you receive the most appropriate care for your burn injury. Always prioritize your safety and comfort, and do not hesitate to seek further medical advice if your symptoms persist or worsen.

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