A 14-year-old student presented with burn injury due to scalding soup exposure 6 hours prior to proper medical attention. Examination found deep rubor and necrosis of the epidermis occurs on left metacarpal carpal joint area where involving 1% of total percentage of body surface area (TBSA). The patient reported severe pain marked at 8 of the universal pain assessment tool (UPAT) measured on a scale of 1 to 10 (10 representing the worst pain possible) with reduced sensation. The burn penetrated into dermis where very rich plexus of nerves and blood vessels are contacted, some wound area blanch with pressure and the pain is severe.
The second degree (partial-thickness) cutaneous burn wounds was diagnosed provisionally. The severity of burn injuries is based upon depth and TBSA involvement, but the definitive determination of wound depth is not be possible for the 12- 24 hours because of vascular occlusive changes. Treatment was begun with topical herbal medicine HLQ ointment [1,2] dressed with cotton wool and bandage with twice per day replacement regimen.
The patient reported UPAT pain was 3 of 10. The serous bullaes formed (Fig.1). Because the epidermal barrier is lost, the wound forms blisters and weeps interstitial fluid.
The patient’s reported numeric rating scale itch intensity (NRSi) was 2 on a scale of 0 to 10 (10 representing the worst possible itch) and UPAT pain at 1 of 10. More bullaes that contain serous fluid found on wound areas (Fig.1). Several chemical mediators with vasoactive and tissue-destructive properties are released, including prostaglandins, bradykinin, serotonin, histamine, lipid peroxides, and oxygen radicals. 
The patient reported no ongoing pain but tenderness. No itch complained. Interstitial edema develops from altered osmotic pressure and capillary permeability.
The hemorrhagic bullae formed on day 4 as the burn penetrates into the dermis. Burn wound heals through reepithelialization (Fig. 1 day 4-14). At the wound edge, the basal cells start migrating across the viable wound bed. They are stimulated by loss of cell–cell contact inhibition, release of local growth factors. Keratinocytes in a HLQ ointment environment can migrate faster than those in a wound that becomes dry and develops a fibrinous scab.
The burn wound itself should initially be rinsed with cold running water for 20 minutes in order to ease pain, reduce heat, and reduce burn depth . Then the wound should be gently cleansed to remove any foreign material. The next step is prevention of infection, followed by creation of a proper healing environment. The challenge that came along with this stand procedure was how to best cover the excised burn wounds if clean running water is not immediately available. The other challenge of treating partialthickness wounds is to encourage re epithelialization within 2 weeks minimizing the chance of hypertrophic scar . Topical ointments such as bacitracin can be used for wounds, but they should be discontinued within a week, since they will invariably cause a rash. Topical antimicrobial include silver sulfadiazine, mafenide acetate, and silver nitrate are traditional burn wound care agents. However silver sulfadiazine is known to be cytotoxic and percutaneous absorption can lead to leukopenia. Silver sulfadiazine also produces a pseudoeschar that may interfere with burn depth assessment and prolonged application may lead to localized argyria [5,6]. Delay (>3 weeks) in wound healing increases the risk of hypertrophic scarring . Second degree burns therapy aimed at minimizing the wound pain and scarring free. HLQ ointment is used on abdominal open wound protection and surgical wound heal in Tsinghua Changgeng Hospital [1,2], we administered it on second degree burn, it produced zero pain of daily dressing changes and achieved complete re-epithelialization in 7-14 days. We closely monitored second degree burn wounds healing process on daily routine follow up; these case studies indicate that HLQ herbal ointment improves time and quality of wound healing.
- Wang Feng, Li Yuanxin. Non-operative self-healing of intestinal fistula after appendix cancer. Tsinghua Changgeng Hospital Bulletin. 2018. Accessed on August 2020.
- Wang Feng, Li Yuanxin. Intestinal fistula with abdominal hemorrhage. Tsinghua Changgeng Hospital Bulletin. 2018. Accessed on August 2020.
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