Scalp burns painful, need urgent care

Michael Jackson is seen about one month after he was burned filming a Pepsi commercial in 1984.
The special effects exploded too early while Michael Jackson filmed a Pepsi commercial in 1984 and his hair caught on fire, causing burns to his scalp.

Jackson blamed that incident for his addiction to pain medication, which was “initially prescribed to cede excruciating pain that I was suffering after recent reconstructive surgery on my scalp,” he said in 1993 in a video statement. Whether through fire, scaling liquid, electricity or other source, burns are extraordinarily painful, said Dr. Peter Grossman, of the Grossman Burn Center in Los Angeles, California, who did not treat Jackson. Anyone whose head gets burned should go to a hospital immediately, Grossman said, especially because burns are “progressive and dynamic.” “If your hair catches on fire and you put it out and everything looks okay, you have to realize that the burn injury may change over the next 24 to 72 hours,” he said. Watch more on Jackson’s accident while filming the commercial ยป The burn victim also may develop a chronic infection around the hair follicles because the pores from which hair would grow are seared shut, Grossman said. Baldness is a characteristic consequence of third-degree scalp burns, which indicates the skin has burned down to the fat layer, Grossman said.

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But sometimes, because of the good blood supply in the scalp, the deeper cells can help regenerate some of the surface skin, and hair can grow back, Grossman said. This may happen with some second-degree burns, which only injure the top layers of the skin. Treatment for burn injuries depends on the severity of the burn, experts say. Once the burn has cooled, health care professionals will clean the wound and remove all nonhealthy tissue in a process called debridement, Grossman said. This may be accomplished by scrubbing, but if the burn is deep enough, the unhealthy tissue must be shaved away, he said. If skin needs to be shaved or cut away, usually the burn victim will require a skin graft to cover the defect, he said. Without a graft, the healing usually takes a lot longer and scar tissue is more noticeable. The graft of skin often comes from another part of the patient’s own body — for example, the thigh — as long as there a sufficient area of nonburned skin for use. The place where that skin came from, called the “donor site,” often causes a lot of pain, but heals within two to three weeks, said Jill Sproul, nurse manager at the Burn Center of the Santa Clara Valley Medical Center in San Jose, California, who did not treat Jackson. The amount of pain that people experience when burned on the scalp varies from person to person, and some may need more pain medications than others, but generally the pain stops when the wounds have healed, Grossman said. This usually takes one to three weeks, depending on the treatment that the patient underwent, he said. “For most people who have some type of treatment, the most intense pain usually is gone within a few weeks,” he said, adding that if the patient had no treatment and the wound healed on its own, there may be prolonged pain. Some people have small sensory nerves that get trapped in scar tissue, and may experience prolonged periods of pain, he said. As for what type of pain medications are appropriate, that depends on the physician and the patient’s needs, Grossman said. This may range from Tylenol or ibuprofen to narcotic pain medications, said Dr. Marianne Cinat, director of the University of California, Irvine, Regional Burn Center.

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Some burn centers may also give patients anti-anxiety drugs such as Valium, depending on individual needs, Sproul said. Patients who receive massive amounts of powerful painkillers at Santa Clara Valley Medical Center’s Burn Center are weaned off them, Sproul said. Most burn patients do not get addicted to pain medications, Cinat and Sproul said. “The ones that do usually come in with some preexisting problem, whether it was street drugs, alcohol or some type of preexisting addiction,” Sproul said, based on her experience at burn centers. There are other symptoms that tend to occur with burns, such as itching, for many months after a burn injury, Grossman and Sproul said. Painkillers would not be given for itching, Sproul said.

Among health care professionals there is greater awareness of pain management now than 25 years ago, when Jackson was burned, Sproul said. Today, in burn centers, higher doses of pain medications can be given, and there is a greater variety of painkillers available than even two decades ago, when Sproul started out in the field, she said.